Diabetes Health Talk

Drug-coated stents appear to be superior to bare metal stents in both efficacy and safety in patients with diabetes, new research shows.

The safety of drug-coated stents versus conventional bare metal stents has been a matter of controversy for years.

Diabetics have a higher prevalence of ischemic heart disease than the general population, but percutaneous coronary intervention (PCI) has limitations in this group, including a higher rate of restenosis and subsequent heart attack and death.

“There is controversy regarding selecting PCI as a treatment for patients with diabetes,” said Dr. David Williams, with Brown University and Rhode Island Hospital in Providence. “One of the major shortcomings of PCI in this patient subset has been a relatively high need to perform repeat revascularization. Drug-eluting stents may offer a potential advantage in that regard, but there is some concern as to whether they are as safe as bare metal stents.”

Mauri presented three-year follow-up data for a subgroup of about 5,000 diabetic patients undergoing PCI with stenting to reopen blocked vessels.

Two-thirds of the patients were treated with drug-eluting stents, and one-third were treated with bare metal stents.

There was an absolute reduction of around 5 percent in the need for repeat procedures in the target vessel and a small, but significant and surprising, decrease in death and subsequent heart attacks.

“It’s appropriate to conclude that drug-eluting stents are superior to bare metal stents in patients with diabetes in regard to reducing the need for repeat revascularization. It also appears to be safe,” Williams said. “Whether there’s actually a benefit in terms of death and heart attack, I would say this is a provocative finding but not firmly established. This report indicates that probably the selection of bare metal stents over drug-eluting stents will be based on the ability of patients to take dual antiplatelet therapy for a sustained period of time.”

A second study, from French researchers, presented at the meeting detailed a way to give individually tailored doses of Plavix (clopidogrel) to patients who had undergone PCI that still reduced the risk of blood clots.