Limits...
Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis.

Stettler C, Allemann S, Wandel S, Kastrati A, Morice MC, Schömig A, Pfisterer ME, Stone GW, Leon MB, de Lezo JS, Goy JJ, Park SJ, Sabaté M, Suttorp MJ, Kelbaek H, Spaulding C, Menichelli M, Vermeersch P, Dirksen MT, Cervinka P, De Carlo M, Erglis A, Chechi T, Ortolani P, Schalij MJ, Diem P, Meier B, Windecker S, Jüni P - BMJ (2008)

Bottom Line: To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus.Collaborative network meta-analysis.Both drug eluting stents were associated with a decrease in revascularisation rates compared with bare metal stents in people both with and without diabetes.

View Article: PubMed Central - PubMed

Affiliation: Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland.

ABSTRACT

Objective: To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus.

Design: Collaborative network meta-analysis.

Data sources: Electronic databases (Medline, Embase, the Cochrane Central Register of Controlled Trials), relevant websites, reference lists, conference abstracts, reviews, book chapters, and proceedings of advisory panels for the US Food and Drug Administration. Manufacturers and trialists provided additional data.

Review methods: Network meta-analysis with a mixed treatment comparison method to combine direct within trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Overall mortality was the primary safety end point, target lesion revascularisation the effectiveness end point.

Results: 35 trials in 3852 people with diabetes and 10,947 people without diabetes contributed to the analyses. Inconsistency of the network was substantial for overall mortality in people with diabetes and seemed to be related to the duration of dual antiplatelet therapy (P value for interaction 0.02). Restricting the analysis to trials with a duration of dual antiplatelet therapy of six months or more, inconsistency was reduced considerably and hazard ratios for overall mortality were near one for all comparisons in people with diabetes: sirolimus eluting stents compared with bare metal stents 0.88 (95% credibility interval 0.55 to 1.30), paclitaxel eluting stents compared with bare metal stents 0.91 (0.60 to 1.38), and sirolimus eluting stents compared with paclitaxel eluting stents 0.95 (0.63 to 1.43). In people without diabetes, hazard ratios were unaffected by the restriction. Both drug eluting stents were associated with a decrease in revascularisation rates compared with bare metal stents in people both with and without diabetes.

Conclusion: In trials that specified a duration of dual antiplatelet therapy of six months or more after stent implantation, drug eluting stents seemed safe and effective in people both with and without diabetes.

Show MeSH

Related in: MedlinePlus

Fig 2 Cumulative incidence of death overall and cardiac death and corresponding hazard ratios (95% credibility intervals) for three stent types estimated from network meta-analysis for pairwise comparisons in people with and without diabetes and restricted to trials with dual antiplatelet therapy of at least six months
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2527175&req=5

fig2: Fig 2 Cumulative incidence of death overall and cardiac death and corresponding hazard ratios (95% credibility intervals) for three stent types estimated from network meta-analysis for pairwise comparisons in people with and without diabetes and restricted to trials with dual antiplatelet therapy of at least six months

Mentions: When the network was restricted to trials with dual antiplatelet therapy for six months or longer (table 1), the hazard ratios of death overall among people with diabetes were all below 1: sirolimus eluting stents compared with bare metal stents 0.88 (95% credibility interval 0.55 to 1.30), paclitaxel eluting stents compared with bare metal stents 0.91 (0.60 to 1.38), and sirolimus eluting compared with paclitaxel eluting stents 0.95 (0.63 to 1.43). Compared with the network of all trials the inconsistency decreased to 20% and credibility intervals of hazard ratios became more narrow in the restricted network. Among patients without diabetes results were much the same in the overall and the restricted network (table 1). The hazard ratio for sirolimus eluting stents compared with bare metal stents was 1.05 (0.69 to 1.73), for paclitaxel eluting stents compared with bare metal stents it was 0.89 (0.66 to 1.18), and for sirolimus compared with paclitaxel eluting stents it was 1.23 (0.82 to 1.69). Figure 2 presents corresponding cumulative incidences of death for the three stent types estimated from the restricted network meta-analysis separately for people with and without diabetes. The incidence of death was about twice as high in people with diabetes compared with people without diabetes. Tests for interaction between treatment effect and diabetes status were negative for all comparisons (P for interaction ≥0.28; also see web extra table D).


Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis.

Stettler C, Allemann S, Wandel S, Kastrati A, Morice MC, Schömig A, Pfisterer ME, Stone GW, Leon MB, de Lezo JS, Goy JJ, Park SJ, Sabaté M, Suttorp MJ, Kelbaek H, Spaulding C, Menichelli M, Vermeersch P, Dirksen MT, Cervinka P, De Carlo M, Erglis A, Chechi T, Ortolani P, Schalij MJ, Diem P, Meier B, Windecker S, Jüni P - BMJ (2008)

Fig 2 Cumulative incidence of death overall and cardiac death and corresponding hazard ratios (95% credibility intervals) for three stent types estimated from network meta-analysis for pairwise comparisons in people with and without diabetes and restricted to trials with dual antiplatelet therapy of at least six months
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2527175&req=5

fig2: Fig 2 Cumulative incidence of death overall and cardiac death and corresponding hazard ratios (95% credibility intervals) for three stent types estimated from network meta-analysis for pairwise comparisons in people with and without diabetes and restricted to trials with dual antiplatelet therapy of at least six months
Mentions: When the network was restricted to trials with dual antiplatelet therapy for six months or longer (table 1), the hazard ratios of death overall among people with diabetes were all below 1: sirolimus eluting stents compared with bare metal stents 0.88 (95% credibility interval 0.55 to 1.30), paclitaxel eluting stents compared with bare metal stents 0.91 (0.60 to 1.38), and sirolimus eluting compared with paclitaxel eluting stents 0.95 (0.63 to 1.43). Compared with the network of all trials the inconsistency decreased to 20% and credibility intervals of hazard ratios became more narrow in the restricted network. Among patients without diabetes results were much the same in the overall and the restricted network (table 1). The hazard ratio for sirolimus eluting stents compared with bare metal stents was 1.05 (0.69 to 1.73), for paclitaxel eluting stents compared with bare metal stents it was 0.89 (0.66 to 1.18), and for sirolimus compared with paclitaxel eluting stents it was 1.23 (0.82 to 1.69). Figure 2 presents corresponding cumulative incidences of death for the three stent types estimated from the restricted network meta-analysis separately for people with and without diabetes. The incidence of death was about twice as high in people with diabetes compared with people without diabetes. Tests for interaction between treatment effect and diabetes status were negative for all comparisons (P for interaction ≥0.28; also see web extra table D).

Bottom Line: To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus.Collaborative network meta-analysis.Both drug eluting stents were associated with a decrease in revascularisation rates compared with bare metal stents in people both with and without diabetes.

View Article: PubMed Central - PubMed

Affiliation: Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland.

ABSTRACT

Objective: To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus.

Design: Collaborative network meta-analysis.

Data sources: Electronic databases (Medline, Embase, the Cochrane Central Register of Controlled Trials), relevant websites, reference lists, conference abstracts, reviews, book chapters, and proceedings of advisory panels for the US Food and Drug Administration. Manufacturers and trialists provided additional data.

Review methods: Network meta-analysis with a mixed treatment comparison method to combine direct within trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Overall mortality was the primary safety end point, target lesion revascularisation the effectiveness end point.

Results: 35 trials in 3852 people with diabetes and 10,947 people without diabetes contributed to the analyses. Inconsistency of the network was substantial for overall mortality in people with diabetes and seemed to be related to the duration of dual antiplatelet therapy (P value for interaction 0.02). Restricting the analysis to trials with a duration of dual antiplatelet therapy of six months or more, inconsistency was reduced considerably and hazard ratios for overall mortality were near one for all comparisons in people with diabetes: sirolimus eluting stents compared with bare metal stents 0.88 (95% credibility interval 0.55 to 1.30), paclitaxel eluting stents compared with bare metal stents 0.91 (0.60 to 1.38), and sirolimus eluting stents compared with paclitaxel eluting stents 0.95 (0.63 to 1.43). In people without diabetes, hazard ratios were unaffected by the restriction. Both drug eluting stents were associated with a decrease in revascularisation rates compared with bare metal stents in people both with and without diabetes.

Conclusion: In trials that specified a duration of dual antiplatelet therapy of six months or more after stent implantation, drug eluting stents seemed safe and effective in people both with and without diabetes.

Show MeSH
Related in: MedlinePlus