Therapy insight: diabetes and drug-eluting stents

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.