By Charlene Laino
NEW ORLEANS -- November 14, 2008 -- In patients with type 2 diabetes, drug-eluting stents are associated with lower rates of mortality, myocardial infarction (MI), and revascularisation compared with bare-metal stents, according to results of a large observational study.
Patients with diabetes account for about one-third of all percutaneous coronary interventions. Previous studies have shown that use of drug-eluting stents is associated with lower rates of revascularisation than bare metal stents, but this is the first trial to show an improvement in MI, stroke, and mortality rates, said researcher Laura Mauri, MD, MSc, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Dr. Mauri reported the findings at a late-breaking clinical trials session on November 10 here at the American Heart Association (AHA) Scientific Sessions. The findings were simultaneously published online on November 10 in Circulation: Journal of the American Heart Association (doi:10.1161/circulationaha.108.820159).
The researchers analysed data obtained from the Massachusetts Data Analysis Center Registry (Mass-DAC) on 5,051 patients with diabetes who underwent percutaneous coronary interventions in Massachusetts' hospitals between April 1, 2003, and September 30, 2004.
Results showed that patients with diabetes were almost twice as likely to receive drug-eluting stents as bare metal stents: (66.1% vs 33.9%, P < .001). Most patients treated with drug-eluting stents received sirolimus-eluting devices, while the rest were treated with paclitaxel-eluting stents.
At 3 years of follow-up, mortality was 14.4% among patients who received drug-eluting stents group and 22.2% in the bare-metal stent group (P < .001).
In a propensity-score matched analysis of 1,476 patients who received drug-eluting stents and 1,476 patients with bare metal stents, the risk-adjusted 3-year mortality rate was 17.5% in the drug-eluting stent group and 20.7% in the bare metal group (P = .02). The risk-adjusted 3-year rates for MI were 13.8% for drug-eluting stents and 16.9% for bare metal stents (P = .02), and 18.4% versus 23.7%, respectively, for target vessel revascularisation (P < .001).
"Drug-eluting stents appear to be safe and effective in diabetic patients, whose diabetes puts them at higher risk of mortality and myocardial infarction than the general population," Dr. Mauri said.
"When possible, drug-eluting stents are preferred over bare-metal stents for patients with diabetes," she said, adding that their use will probably depend on "whether patients can tolerate antiplatelet therapy for longer periods of time."
Antiplatelet therapy is recommended for at least 1 year following drug-eluting stent placement.
[Presentation title: Drug-Eluting and Bare Metal Stenting in Diabetes Mellitus: Results From the Mass-DAC Registry. Late-breaking abstract 5219]
E-Mail this DGDispatch to a colleague
