Next-generation drug-eluting stents may present a new option for diabetic patients with heart disease, according to a new analysis spanning nearly 70 clinical trials.
Although earlier generations of stents didn’t do so well, 2nd generation drug-eluting stents proved just as safe as coronary artery bypass grafting in patients with diabetes, who tend to have more aggressive heart disease and are more likely to need repeat treatment.
Data from previous studies, such as the oft-cited FREEDOM trials, suggested that diabetic patients had a better chance for survival if they skipped the stents and underwent CABG. That survival benefit seems to disappear with newer generations of drug-eluting stents, especially cobalt–chromium everolimus-eluting stents such as Abbott’s (NYSE:ABT) Xience V and Boston Scientific’s (NYSE:BSX) Promus devices, according to the analysis.
"This trial raises a very interesting hypothesis, that if you were to use newer stents, the advantage that you saw in FREEDOM may no longer be present for CABG, [but this] needs to be tested in a randomized trial," lead author Dr. Sripal Bangalore told Medscape.
The analysis incorporated data from 68 clinical trials, encompassing more than 24,000 patients and representing data on use of balloon angiography, bare-metal stents, 1st generation drug-eluting stents and 2nd-generation drug-eluting stents, according to the report.
Mortality risk was higher in bare-metal stents and drug-eluting stents, but leveled out with 2nd-generation drug-eluting stents. The need for repeat treatment also diminished with newer technologies.