The diabetic dilemma: which drug-eluting stent works best?

The relationship between diabetes mellitus and coronary artery disease is well established. The percentage of patients participating in clinical trials of percutaneous coronary intervention (PCI) who have diabetes is quickly rising. Diabetic patients have a worse prognosis than non-diabetics, with generally greater rates of death, myocardial infarction and need for target lesion and vessel revascularization. Stenting has improved the outcome of diabetic patients receiving PCI. Compared with bare-metal stents, the use of drug-eluting stents has resulted in a significant reduction in late lumen loss, binary restenosis, and clinically driven target vessel revascularization even in diabetic patients. Although surgical revascularization remains the recommended revascularization strategy for diabetics, particularly in case of multivessel coronary artery disease, recent progress in interventional devices and techniques have resulted in a changing paradigm for coronary artery revascularization. New stent designs, polymers and drugs are resulting in better outcomes overall, but more research is required to define their relative efficacy relative to other treatment options in this complex subgroup of patients.