Long-term cardiovascular outcomes of biodegradable polymer drug eluting stents in patients with diabetes versus non-diabetes mellitus: a meta-analysis

Abstract

Background Today, diabetes mellitus (DM) has become a worldwide concern. DM is a major risk factor for the development of cardiovascular diseases (CVD). Eligible patients with CVD are treated invasively by percutaneous coronary intervention (PCI) whereby a stent is implanted inside the coronary vessel with the particular lesion to allow sufficient blood flow. Newer scientific research have shown that even though associated with a lower rate of re-stenosis, first-generation drug eluting stents (DES) were associated with a higher rate of late stent thrombosis. Recently, newer stents, namely biodegradable polymer DES (BP-DES) have been developed to overcome the safety issues of earlier generation DES. In this analysis we aimed to systematically compare the long term (≥ 12 months) adverse cardiovascular outcomes observed in DM versus non-DM patients who were implanted with BP-DES. Methods Cochrane central, MEDLINE (Subset PubMed), EMBASE, Web of Science, http://www.ClinicalTrials.gov and Google scholar were searched for relevant publications involving BP-DES in patients with DM versus non-DM and their associated adverse cardiovascular outcomes. The mean follow-up time period ranged from 12 to 120 months. Data analysis was carried out with the latest version of the RevMan software (version 5.4). Based on the Mantel-Haenszel test, risk ratios (RR) with 95% confidence intervals (CI) were calculated and used to represent the results following analysis. Results Seven (7) studies with a total number of 10,246 participants were included in this analysis. Stents which were implanted during PCI were BP-DES. Participants were enrolled from the year 2006 to 2013. Our current results showed that in patients who were implanted with BP-DES, the risks of major adverse cardiac events (RR: 1.30, 95% CI: 1.18–1.43; P = 0.00001), myocardial infarction (RR: 1.48, 95% CI: 1.14–1.93; P = 0.003), all-cause mortality (RR: 1.70, 95% CI: 1.29–2.23; P = 0.0002), cardiac death (RR: 1.93, 95% CI: 1.28–2.93; P = 0.002), target vessel revascularization (RR: 1.35, 95% CI: 1.03–1.77; P = 0.03), target lesion revascularization (RR: 1.28, 95% CI: 1.07–1.54; P = 0.007) and target lesion failure (RR: 1.79, 95% CI: 1.52–2.12; P = 0.00001) were significantly higher in the DM group. Definite and probable stent thrombosis (RR: 1.80, 95% CI: 1.28–2.55; P = 0.0009) were also significantly higher in the DM group. Conclusions Diabetes mellitus was an independent risk factor associated with long term adverse cardiovascular outcomes following PCI with BP-DES.

Ticagrelor monotherapy after a short course of dual antiplatelet therapy with ticagrelor plus aspirin following percutaneous coronary intervention in patients with versus without diabetes mellitus: a meta-analysis of randomized trials

“…DM has always been an independent risk factor for adverse cardiovascular outcomes following PCI. Previous studies have shown DM to be an independent risk factor for the development of adverse cardiovascular outcomes whether with or without insulin therapy [ 21 ], whether with different coronary stents [ 22 ] or with prolonged duration of DAPT [ 23 ]. Studies have also shown that the longer the duration of DM, the higher the major adverse cardiovascular events observed after PCI.…”

Percutaneous Coronary Interventions with Sirolimus-Eluting Alex Plus Stents in Patients with or without Diabetes: 4-Year Results

“…The cardiac death rates in the non-DM patients were markedly lower—0.74% at 12 months, and 2.9% at 48 months. What is somewhat surprising is that the TLR rates were comparable between DM and non-DM patients [ 34 , 35 ]. These results are comparable to those reported in the literature.…”