Drug-eluting stents for diabetes mellitus: a rush to judgment?
The two pivotal U.S. trials of drug-eluting stents do not establish the principle that these stents are superior to thin-strut bare-metal stents for preventing repeat revascularization in patients with diabetes. Neither study was adequately powered to make this determination. Moreover, both studies used thick-strut stents known to have high restenosis rates as controls. Low angiographic follow-up underestimates the true target lesion revascularization rate in the Polymer-Based Paclitaxel-Eluting Stent in Patients with Coronary Artery Disease (TAXUS-IV) trial because of the high incidence of silent ischemia in patients with diabetes. Optimal therapy for diabetic coronary disease should include a comprehensive approach directed toward metabolic normalization in addition to local stent-based therapy.
Finn
Aloke V
AV
Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. afinn1@partners.org
Palacios
Igor F
IF
Kastrati
Adnan
A
Gold
Herman K
HK
D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016503:Drug Delivery Systems; D006801:Humans; D017239:Paclitaxel / Q000008:administration & dosage*; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents
D017239:Paclitaxel; D020123:Sirolimus