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

Stettler, C. and Allemann, S. and Wandel, S. and Kastrati, A. and Morice, M. C. and Schömig, A. and Pfisterer, M. E. and Stone, G. W. and Leon, M. B. and de Lezo, J. S. and Goy, J. J. and Park, S. J. and Sabaté, M. and Suttorp, M. J. and Kelbaek, H. and Spaulding, C. and Menichelli, M. and Vermeersch, P. and Dirksen, M. T. and Cervinka, P. and De Carlo, M. and Erglis, A. and Chechi, T. and Ortolani, P. and Schalij, M. J. and Diem, P. and Meier, B. and Windecker, S. and Jüni, P.. (2008) Drug eluting and bare metal stents in people with and without diabetes : collaborative network meta-analysis. BMJ : British medical journal, Vol. 337 , a1331.

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Official URL: http://edoc.unibas.ch/dok/A6007298

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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 thera of six months or more after stent implantation, drug eluting stents seemed safe and effective in people both with and without diabetes.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Kardiologie (Pfisterer)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Kardiologie (Pfisterer)
UniBasel Contributors:Pfisterer, Matthias E.
Item Type:Article, refereed
Article Subtype:Further Journal Contribution
Bibsysno:Link to catalogue
Publisher:British Medical Journal
ISSN:0959-535X
Note:Publication type according to Uni Basel Research Database: Journal item
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Last Modified:20 Jun 2014 07:55
Deposited On:20 Jun 2014 07:55

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