Coronary intervention in the diabetic patient: improved outcome following stent implantation compared with balloon angioplasty.
BACKGROUND
Diabetic patients undergoing coronary interventional procedures are at increased risk of restenosis and adverse clinical events. The relative impact of stents compared with balloon angioplasty on the outcome of percutaneous intervention in diabetics remains controversial.


OBJECTIVE
The goal of this study was to determine whether stent placement was superior to balloon angioplasty in reducing restenosis of diabetic patients undergoing coronary intervention.


METHODS
The STRESS Trial was a prospective randomized comparison of stent placement and balloon angioplasty in the treatment of new native coronary lesions. Of 594 randomized patients. 92 (16%) were diabetic. In this substudy analysis of the STRESS Trial, the outcomes after stenting and balloon angioplasty in diabetic patients were compared. The primary endpoint was restenosis as determined by angiography at 6 months. Clinical outcomes at 1 year were assessed.


RESULTS
Procedural success was achieved in 82% of diabetic patients assigned to angioplasty and in 100% assigned to stenting (p < 0.01). Compared with angioplasty, stenting resulted in a larger postprocedural lumen diameter (2.34 +/- 0.44 vs. 1.87 +/- 0.52 mm, p < 0.001) and greater acute luminal gain (1.61 +/- 0.47 vs. 1.06 +/- 0.46 mm, p < 0.001). At 6 months, stenting conferred a larger lumen (1.69 +/- 0.57 vs. 1.38 +/- 0.60 mm, p = 0.03) and greater net luminal gain (0.97 +/- 0.55 vs. 0.52 +/- 0.52 mm, p < 0.001). Restenosis occurred in 60% of the angioplasty group and in 24% of the stent group (p < 0.01). This was accompanied by a lower need for repeat target vessel revascularization after stenting (31 vs. 13%, p < 0.03).


CONCLUSIONS
Compared with balloon angioplasty, stent placement in diabetic patients with focal de novo lesions resulted in superior procedural results, reduced restenosis, and improved clinical outcome with fewer repeat revascularization procedures.
Savage
Michael P
MP
Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. dorothy.e.lennox@mail.tju.edu
Fischman
David L
DL
Schatz
Richard A
RA
Leon
Martin B
MB
Baim
Donald S
DS
Brinker
Jeffrey
J
Hirshfeld
John
J
Goldberg
Sheldon
S
D000800:Angioplasty, Balloon; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome