Drug-eluting stent outcomes in diabetes

Abstract

Diabetic population still remains a challenging subgroup of patients for percutaneous coronary intervention (PCI). However, with rapid advancements of PCI techniques, devices and adjunctive drug therapy, clinical outcomes for diabetic patients after PCI have markedly improved. The plethora of recent encouraging data with newer generation drug-eluting stent (DES), with a lower frequency of major cardiac adverse events, lead to an increasing use of DES in this particular high-risk population. However, diabetes remains an important risk factor for coronary events, even in the DES era. This review summarizes the outcomes in diabetic patients undergoing PCI with DES implantation.

Keywords::

• coronary artery disease
• coronary stents
• diabetes mellitus
• drug-eluting stents
• outcomes

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The prevalence of diabetes mellitus is still increasing and it is associated with increased cardiovascular morbidity and mortality. Diabetic patients also have multiple comorbidities, for example, heart failure, renal failure, peripheral vascular diseases, making coronary revascularization in this patient subset more difficult.

• With the advent of drug-eluting stent (DES), the outcomes of percutaneous coronary intervention in diabetics have substantially improved when compared with those treated with bare-metal stents or balloon angioplasty. However, they are still at higher risks for cardiovascular events than non-diabetics because of their high-risk profiles and complex coronary lesion characteristics.

• When compared with BMS, first-generation DES are more effective in reducing the rate of restenosis and repeat revascularization with comparable safety outcomes including mortality and late stent thrombosis in diabetic patients.

• The development of new-generation DES with improved stent designs and polymers has shown some promising results in the treatment of diabetics. However, no single DES has demonstrated to be superior to others in terms of hard clinical end points and therefore it is still controversial which DES or DES type should be used in diabetics.

• Some studies have shown that there is an interaction between diabetic type and DES types. Further dedicated studies should further evaluate whether the clinical outcomes will be different according to diabetic types when a specific DES type is used.

• The novel DES type, bioabsorbable stent with its temporary scaffolding, is an attractive option in the treatment of diabetics. However, its efficacy in diabetics has yet to be determined.

• Despite these technological advances in stent technologies, diabetics with complex, multiple vessel disease may still benefit from coronary artery bypass grafting.

Notes