Coronary Stent Failure in Patients With Diabetes: A Nationwide Observational Study From SWEDEHEART

Area of Science:

• Cardiology
• Diabetes Mellitus
• Biomedical Engineering

Background:

• The association between diabetes and coronary stent failure, particularly with second-generation drug-eluting stents (DES), requires further clarification.
• Understanding this relationship is crucial for optimizing cardiovascular care in diabetic patients.

Purpose of the Study:

• To evaluate the risk of stent failure in patients with type 1 and type 2 diabetes compared to non-diabetic individuals following second-generation DES implantation.

Main Methods:

• A nationwide cohort study in Sweden included 160,523 patients receiving second-generation DES between 2010 and 2020.
• Patients were categorized into type 1 diabetes, type 2 diabetes, and no diabetes groups.
• Stent failure (in-stent restenosis or stent thrombosis) was the primary endpoint, analyzed using Cox regression models with sensitivity analyses.

Main Results:

• The study included 160,523 patients: 2,406 with type 1 diabetes, 43,377 with type 2 diabetes, and 114,740 without diabetes.
• Over a mean follow-up of 4.5 years, 5,510 stent failure events occurred.
• Adjusted hazard ratios for stent failure were 2.28 (95% CI 1.97-2.65) for type 1 diabetes and 1.35 (95% CI 1.27-1.44) for type 2 diabetes compared to non-diabetic individuals.

Conclusions:

• Individuals with type 1 and type 2 diabetes exhibit a significantly higher risk of second-generation DES stent failure compared to non-diabetic individuals.
• Both in-stent restenosis and stent thrombosis contribute to the elevated risk of stent failure in diabetic patients.