Recently an excess of acute adverse coronary events has been reported among diabetic patients treated with drug eluting coronary stents (DES) who received short-term (<6 months) dual antiplatelet therapy (Circulation 2007;115:1440-55).
Stettler and colleagues extended a previous meta-analysis to 35 trials involving 14,799 patients (3,852 with and 10,947 without diabetes) involving at least 6 months of aspirin and clopidogrel therapy. 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). These findings suggest that earlier concerns over increased mortality associated with DES use may in part be due to inadequate duration of antiplatelet therapy.
Among patients with diabetes, DES appears to be as safe and effective as using bare metal stents (BMS), provided patients receive an adequate duration of dual antiplatelet pharmacotherapy. Therefore, in patients in whom drug compliance might be a problem, an alternative strategy involving BMS or bypass surgery should be considered.
- Stettler C, Allemann S, Wandel S, et al. Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis. BMJ 2008;337:a1331.