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Bundhun PK, Soogund MZS, Pursun M, Chen MH. Stent thrombosis and adverse cardiovascular outcomes observed between six months and five years with sirolimus-eluting stents and other drug-eluting stents in patients with Type 2 diabetes mellitus complicated by coronary artery disease: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4130. [PMID: 27399125 PMCID: PMC5058854 DOI: 10.1097/md.0000000000004130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This study aimed to compare 6 months to 5 years stent thrombosis (ST) and adverse cardiovascular outcomes associated with sirolimus-eluting stents (SES) and other drug-eluting stents (DES) in patients with type 2 diabetes mellitus (T2DM).Electronic databases were searched for studies comparing SES with other DES in patients with T2DM. Total ST, definite ST, probable ST, and other adverse cardiovascular outcomes reported between 6 months and 5 years were considered as the clinical end points in this study. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for categorical variables and the pooled analyses were performed with RevMan 5.3 software.Twenty-nine studies involving a total number of 25,729 patients with diabetes were included in this meta-analysis. SES were not associated with significantly higher total, definite, and probable STs with OR: 0.95, 95% CI: 0.77-1.17, P = 0.62; OR: 0.94, 95% CI: 0.65-1.37, P = 0.76; and OR: 1.05, 95% CI: 0.77-1.45, P = 0.74, respectively. SES were also noninferior to the other non-sirolimus eluting drug eluting stents (non-SE DES) in terms of all-cause mortality, cardiac death, myocardial infarction, and stroke with OR: 0.92, 95% CI: 0.82-1.03, P = 0.16; OR: 1.09, 95% CI: 0.88-1.35, P = 0.44; OR: 0.92, 95% CI: 0.80-1.06, P = 0.26; and OR: 0.79, 95% CI: 0.49-1.28, P = 0.43, respectively. Target vessel revascularization, target lesion revascularization, and major adverse cardiac events were also similarly reported between SES and non-SE DES with OR: 1.04, 95% CI: 0.83-1.31, P = 0.72; OR: 1.25, 95% CI: 0.95-1.64, P = 0.11; and OR: 1.06, 95% CI: 0.90-1.25, P = 0.49, respectively.During this particular follow-up period, SES were not associated with any increase in ST among these patients with T2DM. Mortality and other adverse cardiovascular outcomes were also not significantly different between these 2 groups. Hence, SES should be considered neither superior nor inferior to other DES. They are expected to be equally effective and safe to use in patients with T2DM.
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Affiliation(s)
| | | | - Manish Pursun
- Guangxi Medical University, Nanning, Guangxi, PR China
| | - Meng-Hua Chen
- Institute of Cardiovascular Diseases, the First Affiliated Hospital
- Correspondence: Meng-Hua Chen, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, 530027, PR China (e-mail: )
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Bartorelli AL, Egidy Assenza G, Abizaid A, Banning A, Džavík V, Ellis S, Gao R, Holmes D, Ho Jeong M, Legrand V, Neumann FJ, Spaulding C, Worthley SG, Urban P. One-year clinical outcomes after sirolimus-eluting coronary stent implantation in diabetics enrolled in the worldwide e-SELECT registry. Catheter Cardiovasc Interv 2015; 87:52-62. [DOI: 10.1002/ccd.26026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 04/12/2015] [Accepted: 04/18/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network; Toronto Canada
| | | | - Runlin Gao
- Cardiovascular Institute and Fu Wai Hospital; Beijing China
| | | | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital; Gwang Ju Korea
| | | | | | - Christian Spaulding
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris; Paris Descartes University and INSERM; U 970 Paris France
| | - Stephen G. Worthley
- Cardiovascular Investigation Unit Royal Adelaide Hospital; Adelaide Australia
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Buja P, Facchin M, Musumeci G, Frigo AC, Saia F, Menozzi A, Meliga E, Sardella G, Tamburino C, Tarantini G. Paclitaxel- and sirolimus-eluting stents in older patients with diabetes mellitus. Catheter Cardiovasc Interv 2013; 81:1117-24. [DOI: 10.1002/ccd.24636] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 08/28/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Paolo Buja
- Department of Cardiac, Thoracic, and Vascular Sciences; University of Padua Medical School; Padua; Italy
| | - Michela Facchin
- Department of Cardiac, Thoracic, and Vascular Sciences; University of Padua Medical School; Padua; Italy
| | - Giuseppe Musumeci
- Cardiovascular Department; Ospedali Riuniti di Bergamo; Bergamo; Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, and Vascular Sciences; University of Padua Medical School; Padua; Italy
| | - Francesco Saia
- Department of Cardiology; University of Bologna, Policlinico S. Orsola-Malpighi; Bologna; Italy
| | - Alberto Menozzi
- Unità Operativa di Cardiologia; Dipartimento Cardio-Polmonare; Azienda Ospedaliero-Universitaria di Parma; Parma; Italy
| | - Emanuele Meliga
- Department of Interventional Cardiology; Mauriziano Hospital; Turin; Italy
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrologic, and Geriatric Sciences, Sapienza; University of Rome; Policlinico Umberto I; Rome; Italy
| | - Corrado Tamburino
- Cardiology Department; Ferrarotto Hospital; University of Catania; Catania; Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, and Vascular Sciences; University of Padua Medical School; Padua; Italy
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Kufner S, de Waha A, Tomai F, Park SW, Lee SW, Lim DS, Kim MH, Galloe AM, Maeng M, Briguori C, Dibra A, Schömig A, Kastrati A. A meta-analysis of specifically designed randomized trials of sirolimus-eluting versus paclitaxel-eluting stents in diabetic patients with coronary artery disease. Am Heart J 2011; 162:740-7. [PMID: 21982668 DOI: 10.1016/j.ahj.2011.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 07/13/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is an ongoing debate on the optimal drug-eluting stent (DES) in diabetic patients with coronary artery disease. We addressed this issue by making a synthesis of the available evidence on the relative long-term efficacy and safety of sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) in these patients. METHODS Individual patient data were analyzed from 6 randomized trials specifically designed to compare SES with PES in diabetic patients. In total, 1183 patients were followed up for a median of 3.9 years (25th, 75th percentiles 3.4-4.5 years). The primary efficacy end point was target lesion revascularization (TLR). The composite of death and myocardial infarction (MI) was the primary safety end point. Stent thrombosis was a secondary end point. Overall hazard ratios (HRs) with 95% CIs were calculated as summary estimates. RESULTS No significant heterogeneity was seen across the 6 randomized trials for all analyzed events. Sirolimus-eluting stent was associated with a significant reduction in the risk of TLR (HR 0.65 [0.47-0.91], P = .01). No significant differences were observed regarding the risk of death or MI (HR 1.04 [0.74-1.45], P = .83) and stent thrombosis (HR 1.00 [0.31-3.30], P = .67). Mortality was also not affected by the type of DES (HR 0.95 [0.65-1.39], P = .79). CONCLUSIONS In diabetic patients with coronary artery disease, SES leads to a sustained reduction in the risk of TLR compared with PES. Both these DES types are, however, comparable with respect to the risk of stent thrombosis, MI, or death over long-term follow-up.
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Briguori C, Airoldi F, Visconti G, Focaccio A, Caiazzo G, Golia B, Biondi-Zoccai G, Ricciardelli B, Condorelli G. Novel Approaches for Preventing or Limiting Events in Diabetic Patients (Naples-Diabetes) Trial. Circ Cardiovasc Interv 2011; 4:121-9. [PMID: 21364149 DOI: 10.1161/circinterventions.110.959924] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Carlo Briguori
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
| | - Flavio Airoldi
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
| | - Gabriella Visconti
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
| | - Amelia Focaccio
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
| | - Gianluca Caiazzo
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
| | - Bruno Golia
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
| | - Giuseppe Biondi-Zoccai
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
| | - Bruno Ricciardelli
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
| | - Gerolama Condorelli
- From the Laboratory of Interventional Cardiology and Department of Cardiology (C.B., G.V., A.F., G. Caiazzo, B.G., B.R.), Clinica Mediterranea, Naples, Italy; Laboratory of Interventional Cardiology IRCCS Multimedica (F.A.), Milan, Italy; the Division of Cardiology (G.B.-Z.), University of Modena e Reggio Emilia, Modena, Italy; and Dipartimento di Biologia e Patologia Cellulare e Molecolare (G. Condorelli), “Federico II” University, Naples, Italy
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Rana JS, Venkitachalam L, Selzer F, Mulukutla SR, Marroquin OC, Laskey WK, Holper EM, Srinivas VS, Kip KE, Kelsey SF, Nesto RW. Evolution of percutaneous coronary intervention in patients with diabetes: a report from the National Heart, Lung, and Blood Institute-sponsored PTCA (1985-1986) and Dynamic (1997-2006) Registries. Diabetes Care 2010; 33:1976-82. [PMID: 20519661 PMCID: PMC2928347 DOI: 10.2337/dc10-0247] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the association of successive percutaneous coronary intervention (PCI) modalities with balloon angioplasty (BA), bare-metal stent (BMS), drug-eluting stents (DES), and pharmacotherapy over the last 3 decades with outcomes among patients with diabetes in routine clinical practice. RESEARCH DESIGN AND METHODS We examined outcomes in 1,846 patients with diabetes undergoing de novo PCI in the multicenter, National Heart, Lung, and Blood Institute-sponsored 1985-1986 Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry and 1997-2006 Dynamic Registry. Multivariable Cox regression models were used to estimate the adjusted risk of events (death/myocardial infarction [MI], repeat revascularization) over 1 year. RESULTS Cumulative event rates for postdischarge (31-365 days) death/MI were 8% by BA, 7% by BMS, and 7% by DES use (P = 0.76) and for repeat revascularization were 19, 13, and 9% (P < 0.001), respectively. Multivariable analysis showed a significantly lower risk of repeat revascularization with DES use when compared with the use of BA (hazard ratio [HR] 0.41 [95% CI 0.29-0.58]) and BMS (HR 0.55 [95% CI 0.39-0.76]). After further adjustment for discharge medications, the lower risk for death/MI was not statistically significant for DES when compared with BA. CONCLUSIONS In patients with diabetes undergoing PCI, the use of DES is associated with a reduced need for repeat revascularization when compared with BA or BMS use. The associated death/MI benefit observed with the DES versus the BA group may well be due to greater use of pharmacotherapy.
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Affiliation(s)
- Jamal S Rana
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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