TY - JOUR
T1 - Drug eluting and bare metal stents in people with and without diabetes
T2 - Collaborative network meta-analysis
AU - Stettler, Christoph
AU - Allemann, Sabin
AU - Wandel, Simon
AU - Kastrati, Adnan
AU - Morice, Marie Claude
AU - Schömig, Albert
AU - Pfisterer, Matthias E.
AU - Stone, Gregg W.
AU - Leon, Martin B.
AU - De Lezo, José Suárez
AU - Goy, Jean Jacques
AU - Park, Seung Jung
AU - Sabaté, Manel
AU - Suttorp, Maarten J.
AU - Kelbaek, Henning
AU - Spaulding, Christian
AU - Menichelli, Maurizio
AU - Vermeersch, Paul
AU - Dirksen, Maurits T.
AU - Cervinka, Pavel
AU - De Carlo, Marco
AU - Erglis, Andrejs
AU - Chechi, Tania
AU - Ortolani, Paolo
AU - Schalij, Martin J.
AU - Diem, Peter
AU - Meier, Bernhard
AU - Windecker, Stephan
AU - Jüni, Peter
PY - 2008/9/20
Y1 - 2008/9/20
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=52649149924&partnerID=8YFLogxK
M3 - Article
AN - SCOPUS:52649149924
SN - 0959-8146
VL - 337
SP - 668
EP - 672
JO - BMJ
JF - BMJ
IS - 7671
ER -