Paclitaxel-eluting stents in the treatment of longer lesions. Focus on patients with diabetes - TAXUS Diabetes Meta-analysis

Description:

The goal of the meta-analysis was to evaluate the use of paclitaxel-eluting stents compared with bare metal stents in nondiabetic patients, diabetic patients, and insulin-dependent patients who were enrolled in TAXUS II, IV, or VI trials.

Study Design

Study Design:

Patients Enrolled: 2,289
Mean Follow Up: Nine months
Mean Patient Age: Mean age 62 years

Drug/Procedures Used:

Patients enrolled in the TAXUS II, IV, and VI trials were included in the meta-analysis. Briefly, these trials compared paclitaxel-eluting stents with bare metal stents in patients with de novo lesions and showed a significant reduction in restenosis and target lesion revascularization. For the present meta-analysis, patients were categorized as nondiabetic (n=906 for bare stent group and n=925 for paclitaxel-eluting stent group), diabetic patients (n=242 for bare stent group and n=216 for paclitaxel-eluting stent group), and insulin-dependent (n=83 for bare stent group and n=71 for paclitaxel-eluting stent group). Diabetes was defined as requiring medical therapy.

Principal Findings:

Reference vessel diameter was smaller in diabetic patients compared with nondiabetic patients (2.69 mm vs. 2.76 mm, p=0.0002) while lesion length was longer (14.8 mm vs. 13.9 mm, p=0.02). Consequently, stent length was longer in diabetic patients (23.5 mm vs. 22.1 mm, p=0.008).

Target lesion revascularization was lower in the paclitaxel-eluting stent group compared with bare metal stent in nondiabetics (4.6% vs. 14.2%, p<0.0001), diabetics, and insulin-dependent patients. In-stent binary restenosis was also lower in the paclitaxel-eluting stent group compared with bare metal stent in nondiabetics (4.9% vs. 22.9%, p<0.0001), diabetics (4.4% vs. 32.9%), and insulin-dependent patients, as was in-segment binary restenosis. In-stent lesion length was shorter in the paclitaxel-eluting stent group compared with bare metal stent in nondiabetics (0.36 mm vs. 0.86 mm), diabetics (0.36 mm vs. 1.03 mm), and insulin-dependent patients (0.33 mm vs. 1.01 mm), as was percent diameter stenosis (19.0% vs. 36.2% for nondiabetics; 19.4% vs. 41.8% for nondiabetics).

Interpretation:

Among patients undergoing percutaneous coronary intervention on a de novo lesion, paclitaxel-eluting stents were associated with improved angiographic outcomes compared with bare metal stents in the cohort of nondiabetics, diabetics, and insulin-dependent patients. Diabetic patients often have more diffuse disease with smaller vessels and longer lesions.

Additionally, restenosis is often more frequent in diabetics than nondiabetics, as supported by the data in the present meta-analysis. While restenosis was lower in the paclitaxel-eluting stent group compared with bare metal stents, it is unknown whether the paclitaxel-eluting or sirolimus-eluting stent would be more efficacious in the diabetic population.

References:

Dawkins KD. TAXUS VI: paclitaxel-eluting stents in the treatment of longer lesions. Focus on patients with diabetes. Paper presented at the European Society of Cardiology Congress 2004, 29 August-1 September, Munich, Germany.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease

Keywords: Paclitaxel, Coronary Artery Disease, Insulin, Metals, Drug-Eluting Stents, Constriction, Pathologic, Sirolimus, Diabetes Mellitus, Percutaneous Coronary Intervention


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