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  • Review Article
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Therapy Insight: diabetes and drug-eluting stents

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 143–150 (2007)Cite this article

Abstract

Individuals with diabetes mellitus usually present with accelerated atherosclerosis, more diffuse disease, concomitant comorbidities and have an increased risk for restenosis. Evidence confirmed the superiority of CABG surgery over balloon angioplasty with or without bare-metal stenting for diabetic patients requiring multivessel revascularization. More recently, drug-eluting stents (DESs) have emerged as the predominant percutaneous strategy in patients with coronary artery disease. This Review summarizes the knowledge on coronary stenting in diabetics. Although the rate of restenosis is dramatically reduced with the use of DESs compared with bare-metal stents, diabetic patients continue to face higher adverse cardiac event rates when compared with nondiabetic patients. Whether there are differences in the effectiveness of paclitaxel-eluting or sirolimus-eluting stents is still debated. Late outcome might be overshadowed by clinical issues such as late stent thrombosis or restenosis, particularly in diabetic patients with renal failure or complex lesions, and after premature interruption of antiplatelet agents. Longer follow-up in larger populations is thus needed to confirm the long-term safety and efficacy. The superiority or the equivalence of DESs over CABG surgery for multivessel disease has not yet been demonstrated. Thus, although evidence supports DES use in diabetics, further data are needed to better define the management of diabetic patients with coronary artery disease.

Key Points

  • When considering which revascularization strategy to use, the greater atherosclerotic burden in patients with diabetes must be considered, as well as the accelerated progression of the disease seen in these patients

  • Although the rate of restenosis in patients both with and without diabetes is markedly lower with the use of drug-eluting stents than with bare-metal stents, diabetes remains a significant risk factor for restenosis even when using drug-eluting stents

  • Until now, there is no definite evidence of greater performance of any particular type of drug-eluting stent, leaving the physician to choose the type of drug-eluting stent that seems the most appropriate for the type of lesion to be treated

  • Until more data are available, physicians should be aware of the potentially high risk of stent thrombosis when interrupting antiplatelet agent regimens in patients with diabetes, particularly if renal insufficiency is present or when a bifurcation lesion is treated

  • While waiting for results of ongoing clinical trials (e.g. the FREEDOM and SYNTAX studies), CABG surgery should remain the preferred treatment in diabetic patients with multivessel disease

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Figure 1: A comparison of the in-segment restenosis rate in patients with or without diabetes assigned bare-metal stent or drug-eluting stent implantation
Figure 2: A comparison of in-segment restenosis rate among patients with diabetes stratified according to treatment type; bare-metal stent group and the drug-eluting stent group

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Author notes

  1. Service de Cardiologie, CHU de Liège Sart-Tilman, 4000 Liège, Belgium vlegrand@chu.ulg.ac.be

Authors and Affiliations

  1. V Legrand is Associate Director of the Cardiology Department and Head of Invasive Cardiology at the Centre Hospitalier Universitaire Sart-Tilman, Liège, Belgium.,

    Victor Legrand

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Legrand, V. Therapy Insight: diabetes and drug-eluting stents. Nat Rev Cardiol 4, 143–150 (2007). https://doi.org/10.1038/ncpcardio0804

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