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DES Safe for Patients with Diabetes
Key Points:
• Endeavor superior to Taxus and Cypher in this patient subgroup.
By TCT Daily Staff
Patients with diabetes who received DES had no increased risk for death or the combination of death and MI, according to results of a network meta-analysis of DES trials that included patients with diabetes.
Also, data from the SCAAR trial, now called SWEDEHEART, indicated that restenosis was halved with DES use in patients with diabetes.
Network analysis study
Peter Juni, MD, of the Institute of Social and Preventive Medicine and CTU Bern, Switzerland, said that a network meta-analysis of 34 randomized controlled trials that compared DES vs. bare-metal stents in 3,852 patients with diabetes found there was no increase in mortality with DES.
Revascularization rates in patients with diabetes were decreased with both sirolimus-eluting stents and paclitaxel-eluting stents when compared with bare-metal stents .
Possible harm with DES in earlier trials that were included in the meta-analysis was likely due to inappropriately short duration of dual antiplatelet therapy, Juni said.
SCAAR/SWEDEHEART
Ulf Stenestrand, MD, PhD, associate professor of cardiology at the University Hospital Linkoping, Sweden, said that at four-year follow-up, there was no difference in the primary endpoint of death or MI in patients receiving one stent vs. patients receiving multiple stents. There were 4,358 patients in the one-stent group and 2,284 in the multiple-stent group.
Restenosis was significantly associated with new MI (P,.001) in a multivariate analysis, Stenestrand said. The researchers also examined the possible differences between various DES and found no difference in restenosis rates between Taxus Liberté and Taxus Express (Boston Scientific); there was a higher rate of restenosis in patients with the Endeavor stent vs. the two Taxus stents and the Cypher (Cordis) stent .
"There appears to be a difference in different brands of DES," Stenestrand said. "DES is always superior in patients with diabetes, but you should choose a DES that is effective in diabetic patients."
Disclosures:
• Dr. Stenestrand reports no relevant conflicts of interest.
• Dr. Juni reports no relevant conflicts of interest.
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