Role of drug eluting stents in diabetic patients

Franck Boccara ^1*, Emmanuel Teiger ² and Ariel Cohen ¹

¹ Saint Antoine University Hospital, France
² Henri Mondor University Hospital, Assistance Publique-H&pitaux de Paris and Universit&eacu Paris XII, France

^* To whom correspondence should be addressed. E-mail: franck.boccara{at}sat.ap-hop-paris.fr.

Accepted 11 January 2006

Abstract

Coronary artery disease is a major cause of morbidity and mortality in diabetic patients (1). Coronary revascularization, using percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG), haved lower prognosis in terms of repeated interventions and mortality in diabetic compared with the non-diabetic population (2). In the late 80s, the BARI trial [1988-1991] demonstrated that diabetic patients with three-vessel disease or two-vessel disease involving the proximal left anterior descending artery had greater survival with CABG compared with PCI (without stenting) (76.4% versus 55.7%, p=0.0011) even though at 7-years there was no difference in the non-diabetic population (3). In a more recent study including patients with multi-vessel disease (ARTS 1) (4) the rate of event free survival of the diabetic patients remains better in the CABG group despite a systematic use of stenting in the PCI group. The increased risk of cardiovascular events after CABG in diabetic patients maybe partly due to the higher prevalence of comorbidities including renal failure, congestive heart failure, and peripheral vascular disease. Therefore, the benefits of interventional cardiology in this high-risk subgroup of diabetic patients remains to be proven. Balloon angioplasty versus bare metal stent Before the stent era, the rate of coronary restenosis was higher with balloon angioplasty alone in diabetic compared with non-diabetic patients (50 to 62% versus 25 to 35%) (5). The development of bare metal stenting (BMS) and more recently of drug-eluting stent (DES) has changed dramatically the prognosis of PCI in this population. BMS has been associated with a significant improvement in midterm angiographic follow-up in diabetic patients with a similar coronary restenosis rate compared with non-diabetic patients of 25% (6). Van Belle et al. (7) have shown that the angiographic benefit was correlated with clinical improvement at 4-years with a reduction in the combined end point (cardiac death and non-fatal myocardial infarction) in the diabetic stenting group compared

Keywords: coronary revascularization, diabetes mellitus, drug eluting stent, prognosis

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