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Objective To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus. Design Collaborative network meta-analysis. Data sources Electronic databases (Medline, Embase, the Cochrane Central Register of Controlled Trials), relevant websites, reference lists, conference abstracts, reviews, book chapters, and proceedings of advisory panels forthe US Food and Drug Administration. Manufacturers and trialists provided additional data. Review methods Network meta-analysis with a mixed treatment comparison method to combine direct within trial.comparisons between stents with indirect evidence from othertrials while maintaining randomisation. Overall mortality was the primary safety end point, target lesion revascularisation the effectiveness end point. Results 35 trials in 3852 people with diabetes and 10 947 people without diabetes contributed to the analyses. Inconsistency of the network was substantial for overall mortality in people with diabetes and seemed to be related to the duration of dual antiplatelet therapy (P value for interaction 0.02). Restricting the analysis to trials with a duration of dual antiplatelet therapy of six months or more, inconsistency was reduced considerably and hazard ratios for overall mortality were near one for all comparisons in people with diabetes: sirolimus eluting stents compared with bare metal stents 0.88 (95% credibility interval 0.55 to 1.30), paclitaxel eluting stents compared with bare metal stents 0.91 (0.60 to 1.38), and sirolimus eluting stents compared with paclitaxel eluting stents 0.95 (0.63 to 1.43). In people without diabetes, hazard ratios were unaffected by the restriction. Both drug eluting stents were associated with a decrease in revascularisation rates compared with bare metal stents in people both with and without diabetes. Conclusion In trials that specified a duration of dual antiplatelet therapy of six months or more after stent implantation, drug eluting stents seemed safe and effective in people both with and without diabetes. [ABSTRACT FROM AUTHOR]

This article presents a meta-analysis of outcomes associated with drug-eluting and bare-metal stents. The study sought to see if there was a difference in outcomes between the sirolimus-eluting stents, the paclitaxel-eluting stents and the bare-metal stents. The study found that mortality was similar in all three groups. In comparing sirolimus-eluting stents with bare-metal, the drug-eluting stents were associated with the lowest rate of myocardial infarction. The risk of late definite stent thrombosis was increased with the paclitaxel-eluting stents. The reduction in target lesion revascularisation was more pronounced with the sirolimus-eluting stents which leads the authors to conclude that sirolimus-eluting stents seem to be clinically better than the other two.