Efficacy and safety of limus-eluting versus paclitaxel-eluting coronary artery stents in patients with diabetes mellitus: A meta-analysis.

Objective: The relative efficacy and safety of limus-eluting stent (LES) versus paclitaxel-eluting stent (PES) in DM patients remain unclear.

Methods: The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases were searched from January 2001 to December 2013. Clinical trials that performed head-to-head comparisons of LES versus PES implantation in patients with DM were considered for inclusion.

Results: This meta-analysis included 28 clinical trials involving 23,678 patients: 9953 who underwent sirolimus-eluting stent (SES) implantation, 4209 underwent everolimus-eluting stent (EES) or zotarolimus-eluting stent (ZES) implantation, and 9516 underwent PES implantation. The short-term target lesion revascularization (TLR) rate was significantly lower after SES implantation than after PES implantation (3.6% vs 6.3%; odds ratio (OR): 0.659; P=0.014), but there were no significant differences in the rates of target vessel revascularization (TVR), stent thrombosis (ST), myocardial infarction (MI), all-cause mortality, or major adverse cardiac events (MACE). There were no differences in the longer-term rates of TLR, TVR, ST, MI, all-cause mortality, or MACE between SES versus PES. Second-generation LES (EES or ZES) implantation resulted in lower rates of ST (2.1% vs 3.3%; OR: 0.586; P<0.001), MI (2.3% vs 4.1%; OR: 0.527; P=0.001), and MACE (8.0% vs 10.3%; OR: 0.796; P=0.007) than PES implantation.

Conclusions: In patients with DM, short- and longer-term MACE rates were similar after first-generation LES and PES implantation. The second-generation LES may be better than PES implantation in rates of ST, MI, and MACE.