Abstract 2531: Sirolimus-Eluting Stents Compared to Bare Metal Stents in Patients with Diabetes Mellitus: Patient-Level Meta-Analysis of Randomized Trials
Although it is widely believed that patients with diabetes mellitus obtain the greatest benefit from sirolimus-eluting stent, the evidence on the efficacy and safety of stents of this nature is limited. We performed a meta-analysis based on individual patient data from 4 randomized trials (586 patients) comparing sirolimus-eluting with bare metal stents (mean follow-up interval between 12 and 24 months). The primary efficacy endpoint was the need of reintervention. The primary safety endpoint was all-cause mortality. Myocardial infarction and stent thrombosis rates were also evaluated. There was a significant reduction in the overall hazard of repeat revascularization (HR 0.21, 95% confidence interval [CI] 0.13 to 0.33, P<0.001) with the use of sirolimus-eluting stents. Conversely, the overall hazard of death (HR 1.25, 95% CI 0.53 to 2.97, P=0.61) was not significantly different for patients receiving sirolimus-eluting stents compared to bare metal stents. Similarly, the overall hazard of stent thrombosis (HR 0.49, 95% CI 0.10 to 2.31, P=0.37) and myocardial infarction (HR 0.69, 95% CI 0.36 to 1.31, P=0.26) were comparable among patients treated with sirolimus-eluting or bare metal stents. No evidence of heterogeneity was observed across the trials regarding all endpoints. Use of sirolimus-eluting stents in patients with coronary artery disease and diabetes mellitus is highly effective and safe.