# Safety and Efficacy of Modern Stents in Patients with Metabolic Syndrome
## 4 Discussion
These results suggest that coronary lesion characteristics are more important than the overall extent of coronary atherosclerosis (i.e., single, double, triple vessel coronary artery disease) when it comes to establishing prognosis. Thus, the complexity of culprit lesions of patients enrolled can explain the higher rates of MACE in patients with 1 st generation DES or bare metal stenting. However, the results were not statistically significant. Our study showed similar outcomes in patients with metabolic syndrome regardless of the stent type. We found that stent type in the presence of MS had no significant impact on all-cause mortality or TLR. Despite the well-known benefits of 2 nd generation DES, there is no clear evidence of different stent type performance in patients with MS in the settings of an acute coronary syndrome. However, studies comparing stents have been conducted in patients with DM. Results from the Massachusetts Data Analysis Center Registry showed reduced mortality, repeat revascularization rates and myocardial infarction in patients with DES stenting compared to BMS. Nevertheless, the study had several limitations, the data was observational and did not include angiographic characteristics [33]. These findings are in contrast with our results and could be explained by the differences in methodology, acute settings and follow up period. Instead, a meta-analysis of 10 randomized trials comparing DES to BMS in DM patients, associated DES with lower rate of TLR but no differences compared to BMS regarding MACE or mortality during one year of follow-up [34]. Moreover, one of the latest trials comparing DES to BMS, that followed over 9000 patients for 6 years, showed similar results between patients receiving DES and those receiving BMS in terms of mortality, although there was a lower rate of TLR in the DES group [35]. Our study revealed similar results in terms of mortality and MACE when comparing 2 nd generation DES to other stents including BMS and 1 st generation DES. Additionally, an expected trend toward increased risk of ischemic-driven TLR procedures was observed in patients with 1 st generation DES and bare metal stent implantation. However, the results were not statistically significant. Few trials comparing 1 st vs. 2 nd generation of DES in diabetes patients with ACS resulted in no convincing differences in safety and efficacy outcomes [36; 37], whereas a large meta-analysis in patients with DM and coronary artery disease showed increased beneficial effect of everolimus-eluting stents over 1 st generation DES in terms of TLR, myocardial infarction and stent thrombosis, but no differences in all-cause and cardiac mortality. Moreover, for zotarolimus-eluting stents, the rates for TLR were significantly higher compared to 1 st generation DES and no significant difference in the rates of MACE and cardiac mortality was observed [38]. Our research revealed no significant differences in terms of efficacy between groups, despite the fact that a trend towards reduction in TLR was observed in 2 nd generation DES patients. All these findings were not statistically significant because of the low number of coronary events and revascularization procedures on follow-up. Additionally, our study had a relatively short follow-up period of 1 year, and this may be the reason why we did not detect a statistically significant association between stent type and TLR in the presence of MS. Instead, lower rates of cardiac mortality were recorded in 2 nd generation DES patients, demonstrating a better safety profile of this type of stents. However, all-cause mortality and MACE did not differ between groups. Smaller studies conducted on patients with metabolic syndrome comparing BMS to DES revealed lower rates of restenosis and adverse cardiovascular events in patients underwent DES stenting [39; 40]. In contrast to our research, other studies included patients with both stable and unstable coronary disease; furthermore, some reports excluded patients with ST segment elevation ACS.