PCI in The Patient with Diabetes
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Diagnostic Cardiac Catheterization in the Patient with Diabetes
PCI in the patient with Diabetes
The DIABETES trial was the first randomized multicenter trial examining the efficacy of SES in preventing restenosis in diabetic patients. The trial randomized 160 diabetic patients with de novo coronary stenoses to either SES or BMS. One year dual antiplatelet therapy of aspirin and clopidogrel was routinely prescribed for one year in both arms.
The DIABETES (DIABETes and sirolimus Eluting Stent) trial showed a marked reduction in target lesion revascularization (TLR) with the sirolimus-eluting stent (SES) compared with the bare metal stent (BMS) at 2 year follow-up. However, there was also a significant cumulative rate of revascularization due to atherosclerosis progression in both groups as well as an increase in late stent thrombosis after clopidogrel discontinuation.
The overall MACE rate, defined as death, MI, TLR, or stent thrombosis, was significantly lower in the SES group at the two year follow-up, though this was driven by the considerable reduction in the TLR rate after SES implantation. At the two year follow-up, the rate of TLR was 7.7% in the SES group compared with 35.0% in the BMS group (p<0.001). There were no significant differences in the rates of death or MI between the groups.
The total revascularization rate at two years increased in both the SES and BMS groups (7.7%and 10% respectively; p=0.7) due to progression of atherosclerosis in segments remote from the target lesion.
The beneficial effect of SES implantation in clinical restenosis was independent of diabetes treatment, gender, vessel location, the use of IIb/IIIa inhibitors, stent size, and reference vessel diameter.
Read the news brief of this trial in the WikiDoc News section