Evolution of coronary stents in patients with diabetes: are clinical outcomes still improving?

Abstract

Diabetic patients are prone to diffuse and accelerated atherosclerosis, which increases the likelihood of requiring myocardial revascularization. Diabetes mellitus is a strong risk factor for restenosis following coronary stenting, with greater need for repeat revascularization and inferior clinical outcomes. Despite the recent advances in drug-eluting stent technology, diabetic patients are still at higher risk of adverse clinical events after coronary angioplasty. The focus of this review is to describe the evolution of the percutaneous management of diabetic patients with coronary artery disease and to define if any real progress has been made in terms of safety and efficacy with the use of the second generation drug-eluting stents in this high-risk population.

Keywords::

• coronary angioplasty
• diabetes mellitus
• drug-eluting stents
• outcome
• restenosis

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

• Diabetes mellitus remains a strong clinical predictor of restenosis even in the drug-eluting stents (DES) era.

• First-generation DES reduced angiographic restenosis and the need for repeat revascularization and these advantages were also evident in patients with diabetes.

• In the diabetic population, the improved angiographic outcomes seen with second-generation DES compared with first-generation DES were less obvious but there was improved safety.

• Additional development in DES technology is required with specific targeting of the diabetic population.

Notes