Polymer-free stents for percutaneous coronary intervention in diabetic patients: a systematic review and meta-analysis

<b>Aim:</b> To compare the efficacy of polymer-free drug-eluting stents (PF-DES) versus other stents in diabetic patients with coronary artery disease undergoing percutaneous coronary interventions. <b>Materials &amp; methods:</b> A systematic review and meta-analysis were performed to identify pertinent randomized controlled trials. The primary end point was the occurrence of target lesion failure. <b>Results:</b> Eight randomized controlled trials were included for a total of 4854 subjects. The PF-DES group experienced a trend in favor of a lower rate of target lesion failure (Incidence rate ratio = 0.91; <i>p</i> = 0.11) and a significantly lower rate of cardiac mortality, as compared with the control group (Incidence rate ratio = 0.82; <i>p</i> = 0.04). However, statistical significance was lost if bare-metal stent patients were excluded and a trend in favor of the PF-DES strategy was reported only for cardiac mortality. <b>Conclusion:</b> PF-DES could be a valuable strategy in diabetic patients with coronary artery disease undergoing percutaneous coronary interventions. Polymer-free drug-eluting stents (PF-DES) are a novel type of coronary stent with potential benefits in terms of chronic coronary inflammation. This is a comprehensive, up-to-date, systematic review and meta-analysis of randomized controlled trials comparing the efficacy of PF-DES versus other stents in diabetic patients with coronary artery disease undergoing percutaneous coronary intervention. Patients treated with PF-DES experienced similar prognosis, with a trend toward better outcomes, as compared with conventional stents. PF-DES could represent a novel and effective strategy for treating coronary artery disease in diabetic patients. Polymer-free drug-eluting stents could be a valuable strategy in diabetic patients with coronary artery disease undergoing percutaneous coronary intervention. Graphical summary of the study. IRR: Incidence rate ratio. Polymer-free drug-eluting stents (PF-DES) allow for antiproliferative agent release without the presence of polymers, which leads to chronic coronary inflammation and delayed endothelialization of stent struts. Whether PF-DES could provide prognostic benefits as compared with other types of stents in diabetic populations undergoing percutaneous coronary intervention (PCI) is controversial to date. This study was a comprehensive, up-to-date, systematic review and meta-analysis aimed to compare the efficacy of PF-DES versus other stents in diabetic patients undergoing PCI. A total of eight randomized controlled trials for a total of 4854 subjects were included in the analysis. There was a trend in favor of PF-DES in the primary end point of target lesion failure (IRR = 0.91, [95% CI: 0.81–1.02]; <i>p</i> = 0.11). PF-DES group experienced a significantly lower rate of cardiac mortality, as compared with the control group (IRR = 0.82, [95% CI: 0.68–0.99]; <i>p</i> = 0.04). PF-DES could be a valuable strategy in diabetic patients with coronary artery disease (CAD) undergoing PCI. The pathophysiology underlying these results remains to be addressed. Future larger randomized controlled trials are warranted to address DM subpopulations that could gain more benefit from PF-DES revascularization.