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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.

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Related in: MedlinePlus

Fig 3 Cumulative incidence of myocardial infarction and the composite of death or myocardial infarction 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
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fig3: Fig 3 Cumulative incidence of myocardial infarction and the composite of death or myocardial infarction 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: Table 1 allows a comparison of the results from the network meta-analysis of all trials and the analysis restricted to trials with a dual antiplatelet therapy of six months or more. Among people with diabetes, hazard ratios for drug eluting stents compared with bare metal stents became more beneficial for drug eluting stents for the outcomes of cardiac death, the composite of death or myocardial infarction, and for stent thromboses. The inconsistency decreased mainly for cardiac death and per protocol definitions of stent thromboses. No differences between overall and restricted network meta-analysis were observed for myocardial infarction. Among people without diabetes, results from overall and restricted network meta-analysis were similar. Corresponding cumulative incidences for the three stent types are presented in figures 2 and 3 . Again, incidences were higher in people with diabetes than without, with most pronounced differences observed for cardiac death. Tests for interaction between treatment effect and diabetes status were negative for all comparisons on cardiac death, myocardial infarction, and their composite (P for interaction ≥0.47, see also 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 3 Cumulative incidence of myocardial infarction and the composite of death or myocardial infarction 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

fig3: Fig 3 Cumulative incidence of myocardial infarction and the composite of death or myocardial infarction 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: Table 1 allows a comparison of the results from the network meta-analysis of all trials and the analysis restricted to trials with a dual antiplatelet therapy of six months or more. Among people with diabetes, hazard ratios for drug eluting stents compared with bare metal stents became more beneficial for drug eluting stents for the outcomes of cardiac death, the composite of death or myocardial infarction, and for stent thromboses. The inconsistency decreased mainly for cardiac death and per protocol definitions of stent thromboses. No differences between overall and restricted network meta-analysis were observed for myocardial infarction. Among people without diabetes, results from overall and restricted network meta-analysis were similar. Corresponding cumulative incidences for the three stent types are presented in figures 2 and 3 . Again, incidences were higher in people with diabetes than without, with most pronounced differences observed for cardiac death. Tests for interaction between treatment effect and diabetes status were negative for all comparisons on cardiac death, myocardial infarction, and their composite (P for interaction ≥0.47, see also 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