Comparing the Clinical Outcomes between Drug Eluting Stents and Bare Metal Stents in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials

Bundhun, Pravesh Kumar; Bhurtu, Akash; Soogund, Mohammad Zafooruddin Sani; Long, Manyun

doi:10.1371/journal.pone.0154064

Cited by 19 publications

(12 citation statements)

References 34 publications

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“…Moreover, insulin treatment by itself was shown to be associated with significantly worse cardiovascular outcomes after PCI compared to non-insulin treated diabetes [ 25 , 26 ]. Nevertheless, compared to bare metal stents, drug eluting stents were shown to be associated with a significantly lower rate of repeat revascularization, without any increase in myocardial infarction or mortality in patients with insulin treated diabetes, during a follow up period of 1 year [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of diabetes and early revascularization on the need for late and repeat procedures

Orbach

Halon

Jaffe

et al. 2018

Cardiovasc Diabetol

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BackgroundCoronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear.MethodsCoronary angiography was performed in 12,420 patients between the years 2000–2015 and early revascularization status [none, percutaneous coronary intervention (PCI) or bypass surgery (CABG)] was determined. Subsequent revascularization procedures were recorded over a median follow-up of 67 months and its relation to diabetic and baseline revascularization status was studied.ResultsEarly revascularization status was none in 5391, PCI in 5682 and CABG in 1347 patients. Late revascularization rates were 10, 26 and 11.1% respectively. Diabetes was present in 37%; a stepwise relationship of diabetic status with late revascularization was observed: no diabetes (reference) 14.4%, non-insulin treated diabetes 21% (adjusted HR 1.35, 95% CI 1.23–1.49, p < 0.001) and insulin-treated diabetes 32.8% (adjusted HR 2.20, 95% CI 1.91–2.54, p < 0.001), which was similar in magnitude for each early revascularization state (none, PCI or CABG). Further revascularizations (≥ 2) were also significantly more common in diabetics, in particular if insulin-treated. Glycosylated hemoglobin level was moderately associated with late revascularization in diabetics after early PCI but not following diagnostic catheterization or CABG.ConclusionsDiabetic status graded by treatment, and in particular insulin therapy, is a strong predictor for late or repeat revascularization irrespective of early revascularization status. The high rate of repeat revascularization in diabetics following PCI remains a challenging issue.Electronic supplementary materialThe online version of this article (10.1186/s12933-018-0669-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Impact of diabetes and early revascularization on the need for late and repeat procedures

Orbach

Halon

Jaffe

et al. 2018

Cardiovasc Diabetol

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“…The intermediate and long-term clinical outcomes of DES and bare-metal stents in diabetic population have already been investigated through the best of the study designs -randomized control trials and prospective registries. [17][18][19] One of the other important 300-patient randomized ESSENCE-DIABETES trial succeeded in showing non-inferiority of Everolimus-eluting stents (EESs) compared to first-generation sirolimus-eluting stents with respect to angiographic late lumen loss (LLL) at 8 months with no significant difference in clinical outcomes at 1 year, although the trial was not powered to show a statistical difference with respect to the latter follow ups. 20 Though the study was a prospective trial assessing MACE at the interval of 12 months only, the event rate was little higher (5.3% with SES) than current study in the diabetic patients (4.2%).…”

Section: Discussionmentioning

confidence: 99%

Two-year safety and efficacy of Indigenous Abluminus Sirolimus Eluting Stent. Does it differ amongst diabetics? – Data from en-ABLe- REGISTRY

Sharma

Dani

Desai

et al. 2021

J Cardiovasc Thorac Res

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Introduction: To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics. Methods: In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vessel related myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST). Results: Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/TVR - 1.4% at both the intervals for 2493 patients at 2 yrs. follow-up. TV-MI & ST were 0.36% and0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3%vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0vs 2.1% at 2 years) was significant (P < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST (P > 0.05). Conclusion: Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST.

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“…Studies have shown that DES provide better clinical outcomes compared to BMS. 1 Thus, an analysis that compares CABG to PCI with studies that include BMS would bias against the potential benefits of PCI. In a similar way, conduit selection can impact CABG outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…For PCI, the use of drug eluting stents (DES) significantly reduce the restenosis rate and improve survival. 1 For CABG, the use of multiple instead of single arterial grafts (MAG vs SAG respectively) lead to better patency rate and possibly improved clinical outcome. 2 In this meta-analysis, we compare the contemporary therapeutic options for the treatment of patients with multiple vessel disease: PCI with DES, vs MAG CABG and SAG CABG.…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis Comparing Outcomes of Drug Eluting Stents Versus Single and Multiarterial Coronary Artery Bypass Grafting

Gaudino

Rahouma

Abouarab

et al. 2018

The American Journal of Cardiology

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Relative benefits of coronary artery bypass (CABG) using single and multiple arterial grafting (SAG, MAG) and drug eluting stent (DES) in multivessel coronary disease remain uncertain. We compared SAG, MAG and DES in a pairwise and network meta-analysis. Randomized trials and adjusted observational studies comparing CABG versus DES were included (primary endpoint: long-term mortality; secondary endpoints: operative mortality, perioperative stroke and followup repeated revascularization [RR]). Studies with ≥1.7arterial grafts/patient were classified as MAG. Bayesian network meta-analyses (NMAs) and random-model pairwise meta-analyses were performed. 53,239 patients (8 randomized, 17 observational studies) were included (26,306 DES;26,933 CABG). In pairwise comparison (mean follow-up:5.42 years), CABG (MAG+SAG) was associated with lower long-term mortality (incident rate ratio[IRR]0.77, 95%CI 0.66-0.90), lower RR (IRR 0.37, 95%CI 0.27-0.51), increased perioperative stroke (odds ratio[OR]3.18, 95%CI 1.70-5.97) and similar operative mortality (OR 1.04, 95%CI 0.64-1.70) compared to DES. There was a non-significant trend toward lower long-term mortality for studies with higher mean number of arterial grafts. In NMA, compared to DES, MAG was associated with lower long-term mortality (IRR 0.72, 95%CrI 0.57-0.92) and late RR (IRR 0.32, 95%CrI 0.21-0.49), SAG was associated with lower long-term mortality and RR (IRR 0.80, 95%CrI 0.66-0.97 and IRR 0.42, 95%CrI 0.29-0.61 respectively). In conclusion, CABG was associated with reduced 5-year mortality and need for RR compared to DES. MAG was ranked as the best treatment for the primary and all secondary outcomes.

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Comparing the Clinical Outcomes between Drug Eluting Stents and Bare Metal Stents in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials

Cited by 19 publications

References 34 publications

Impact of diabetes and early revascularization on the need for late and repeat procedures

Impact of diabetes and early revascularization on the need for late and repeat procedures

Two-year safety and efficacy of Indigenous Abluminus Sirolimus Eluting Stent. Does it differ amongst diabetics? – Data from en-ABLe- REGISTRY

Meta-Analysis Comparing Outcomes of Drug Eluting Stents Versus Single and Multiarterial Coronary Artery Bypass Grafting

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