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[Percutaneous coronary intervention in diabetic patients]

Jean-Marc Lablanche1, Guillaume Rosey, Mohamed Zoubidi

  • 1Service de Cardiologie B et Hémodynamíquè, Hôpital Cardiologique, CHU de Lille--Boulevard du Pr. Jules Leclercq, 59037 Lille.

Bulletin De L'Academie Nationale De Medecine
|August 24, 2005
PubMed

Insights

Diabetic patients undergoing percutaneous coronary intervention (PCI) benefit from drug-eluting stents (DES), but face higher stent thrombosis risks. Further trials are needed for multivessel disease in diabetics.

Area of Science:

  • Cardiology
  • Endocrinology
  • Interventional Cardiology

Context:

  • Diabetic patients comprise 25% of percutaneous coronary intervention (PCI) cases.
  • Previous recommendations favored coronary artery bypass graft (CABG) surgery for diabetic patients with multivessel disease.
  • Diabetes is a significant risk factor for adverse cardiovascular outcomes, including death, myocardial infarction, and restenosis.

Purpose:

  • To re-evaluate the indications for PCI in diabetic patients following advancements in stenting and antiplatelet therapies.
  • To assess the efficacy and safety of drug-eluting stents (DES) in diabetic patients undergoing PCI.
  • To compare PCI outcomes in diabetic patients with single-vessel versus multivessel disease.

Summary:

  • Drug-eluting stents (DES) significantly reduce restenosis rates by approximately 80% in diabetic patients undergoing PCI, without impacting mortality or myocardial infarction risk.
  • The EVASTENT study indicated a higher incidence of stent thrombosis in diabetic patients treated with sirolimus-eluting stents (2.5% vs. 0.9%).
  • PCI with DES and abciximab shows promising results for diabetic patients with single-vessel disease, but requires further randomized trial evaluation for multivessel disease.

Impact:

  • PCI, particularly with DES, offers a valuable alternative to CABG for select diabetic patients, especially in high-risk surgical populations.
  • Findings highlight the critical need for enhanced surveillance and potentially novel antithrombotic strategies in diabetic patients post-PCI.
  • Emphasizes the paramount importance of secondary prevention strategies in managing diabetic patients with coronary artery disease.

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