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Drug-Eluting Stents Beat Bare Metal Stents in Diabetics
Date:11/11/2008

>In the largest population-based comparison of stents in diabetics, researchers used data from a mandatory state registry. They identified 5,051 diabetics who underwent PCI at acute-care, non-federal hospitals between April 2003 and September 2004. Diabetic patients at those hospitals were about twice as likely to get DES compared to BMS (66.1 percent vs. 33.9 percent), researchers said.

At three years of follow-up, the unadjusted cumulative endpoint of death was 14.4 percent for DES patients compared to 22.2 percent for BMS patients, Mauri said.

The researchers then matched a subset of 1,476 DES and 1,476 BMS patients to control for 63 potential confounders such as concurrent conditions and medications. In that comparison, they found the risk-adjusted mortality at three years was 17.5 percent for DES patients vs. 20.7 percent, a small but significant 3.2 percent absolute reduction in mortality in DES patients, with no excess adverse events. The choice of BMS or DES was not randomized, but was done at the direction of the treating physician, so it is possible that the patients given DES were different in the number of blood vessel or other characteristics.

Although three-year data were not yet available for rates of heart attack and target vessel revascularization, at two years of follow-up those rates were lower in the DES group compared to the BMS group.

"Diabetic patients represent a large and growing proportion of patients who undergo stenting," Mauri said. "We know that patients with diabetes have a higher incidence of adverse events following the procedure, including higher rates of restenosis (reblockage), heart attack and death related to heart problems."

"Previous studies indicated that drug-eluting stents reduce the rate of restenosis, but there has been controversy about their safety because of conflicting evidence from smaller studies."

Some of those studies found higher mortality associated with DES while othe
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SOURCE American Heart Association
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