糖尿病患者使用DES安全

DES Safe for Patients with Diabetes  

（阜外心血管病医院 高立建 翻译）

• 关键点：在糖尿病亚组，Endeavor优于Taxus 和Cypher

根据一项荟萃分析DES治疗患有糖尿病的冠心病患者的临床试验结果，患有糖尿病的冠心病患者接受DES治疗没有增加死亡或死亡和心肌梗死（MI）联合终点。

SCAAR试验资料，现在也称之为SWEDEHEART研究，表明糖尿病患者应用DES再狭窄减少一半。

网络分析研究

瑞典社会和预防医学研究所Peter Juni医生声称：一项网络分析了34个随机对照试验，比较3852例糖尿病患者应用DES和BMS治疗结果，发现DES组并没有增加死亡率。雷帕霉素药物洗脱支架和紫杉醇药物洗脱支架与金属裸支架相比，再血管化率减低（见图）

 
纳入到荟萃分析当中的早期临床试验中DES的可能危害为不恰当的短期抗血小板治疗。

SCAAR/SWEDEHEART研究

Ulf Stenestrand是瑞典Linkoping大学医院心内科副教授说道：“置入1枚支架和多枚支架患者4年随访结果表明，主要终点死亡或心肌梗死两组没有差别”其中4358例患者入单支架组，2284例患者入双支架组。多变量分析显示再狭窄明显与新发心肌梗死相关（P=0.001），研究者还检验了不同药物洗脱支架支架的可能差异，发现Taxus Liberté和Taxus Express (波士顿科技有限公司)在狭窄率没有差别。而Endeavor支架的再狭窄率较Taxus的两种支架和Cypher（Cordis）支架高（见表）

Stenestrand发表言论：“不同品牌的DES显示有差别，DES治疗糖尿病患者有优势，但是应当选择对糖尿病患者有效的DES。”

（来源：www.tctmd.com）

DES Safe for Patients with Diabetes  

Key Points:

• Endeavor superior to Taxus and Cypher in this patient subgroup.

By TCT Daily Staff

Patients with diabetes who received DES had no increased risk for death or the combination of death and MI, according to results of a network meta-analysis of DES trials that included patients with diabetes.

Also, data from the SCAAR trial, now called SWEDEHEART, indicated that restenosis was halved with DES use in patients with diabetes.

Network analysis study

Peter Juni, MD, of the Institute of Social and Preventive Medicine and CTU Bern, Switzerland, said that a network meta-analysis of 34 randomized controlled trials that compared DES vs. bare-metal stents in 3,852 patients with diabetes found there was no increase in mortality with DES.

Revascularization rates in patients with diabetes were decreased with both sirolimus-eluting stents and paclitaxel-eluting stents when compared with bare-metal stents (see Figure).

Possible harm with DES in earlier trials that were included in the meta-analysis was likely due to inappropriately short duration of dual antiplatelet therapy, Juni said.

SCAAR/SWEDEHEART

Ulf Stenestrand, MD, PhD, associate professor of cardiology at the University Hospital Linkoping, Sweden, said that at four-year follow-up, there was no difference in the primary endpoint of death or MI in patients receiving one stent vs. patients receiving multiple stents. There were 4,358 patients in the one-stent group and 2,284 in the multiple-stent group.

Restenosis was significantly associated with new MI (P,.001) in a multivariate analysis, Stenestrand said. The researchers also examined the possible differences between various DES and found no difference in restenosis rates between Taxus Liberté and Taxus Express (Boston Scientific); there was a higher rate of restenosis in patients with the Endeavor stent vs. the two Taxus stents and the Cypher (Cordis) stent (see Table).

"There appears to be a difference in different brands of DES," Stenestrand said. "DES is always superior in patients with diabetes, but you should choose a DES that is effective in diabetic patients."

Disclosures:

• Dr. Stenestrand reports no relevant conflicts of interest.
• Dr. Juni reports no relevant conflicts of interest.