Abstract 4340: Sirolimus- versus Paclitaxel-Eluting Stents in Diabetic Patients: A Meta-Analysis of Randomized Clinical Trials
Background: Recent data with drug-eluting stents have shown improved clinical outcomes in patients with diabetes mellitus (DM). However, the relative efficacy and safety of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) remains controversial. We performed a meta-analysis of randomized trials comparing SES with PES in diabetic patients.
Methods and results: The published literature was scanned by formal searches of electronic databases such as PubMed from January 2001 to April 2009. All randomized trials on head-to-head comparison of SES versus PES in diabetic patients were examined for analysis. Finally, a total of 5 randomized trials were included in the present meta-analysis, involving 1,173 patients (594 in SES group and 579 in PES group). SES was significantly more effective in the reduction of target lesion revascularization (TLR) (5.1% vs. 11.4%; Odds ratio [OR] 0.41, 95% confidence intervals [CI] 0.26 – 0.64; P<0.001) (Figure 1⇓) and angiographic binary (≥50%) restenosis (5.6% vs. 16.4%; OR 0.30, 95% CI 0.19 – 0.48; P<0.001) compared to PES. In contrast, the differences between SES and PES were not statistically significant with respect to cardiac death (2.2% vs. 2.9%; OR 0.71, 95% CI 0.34 –1.47; P=0.35), myocardial infarction (1.5% vs. 2.6%; OR 0.58, 95% CI 0.26 –1.31; P=0.19) and stent thrombosis (0.6% vs. 1.2%; OR 0.57, 95% CI 0.18 – 0.84; P=0.35).
Conclusions: In patients with DM, SES is superior to PES in reducing the incidences of restenosis and TLR, with nonsignificant differences in terms of cardiac death, myocardial infarction and stent thrombosis. Longer follow-up data will certainly provide important additional information.