title: [Efficacy of sirolimus-eluting stent implantation in diabetic patients with very small vessels (< or = 2.25 mm). Insights from the DIABETES trial].
abstract: OBJECTIVE
  Diabetic patients frequently have small-diameter vessels, which increases their risk of restenosis. The aim of this study was to determine the efficacy of sirolimus-eluting stent implantation in these high-risk patients following percutaneous coronary intervention.
  
  
  METHODS
  Our study population comprised a subset of 85 diabetic patients from the DIABETES (DIABETes and sirolimus Eluting Stent) trial who had very small vessels, defined as those with a reference diameter < or =2.25 mm. In the 100 lesions treated, 49 sirolimus-eluting stents and 51 bare-metal stents were used. Glycoprotein IIb/IIIa inhibitors were used as recommended by the protocol and dual antiplatelet therapy was administered for 1 year.
  
  
  RESULTS
  Baseline clinical and angiographic characteristics were comparable in the two groups. The patients' mean age was 66 (9) years, 42% were women, and 37% were insulin-dependent. On average, the lesion length was 15.0 (9.0) mm and the reference diameter was 1.9 (0.2) mm. At 9-month follow-up, both late lumen loss and the restenosis rate were significantly lower in the sirolimus-eluting stent group than in the bare-metal stent group, at -0.03 (0.3) mm vs 0.44 (0.5) mm (P< .001), and 9.1% vs 39.1% (P=.001), respectively. These differences were also observed in the subgroup of insulin-dependent patients. At 1-year follow-up, the stent thrombosis rate was 0% in the sirolimus-eluting stent group, whereas two patients in the bare-metal stent group presented with stent thrombosis.
  
  
  CONCLUSIONS
  Sirolimus-eluting stent implantation in diabetics with very small vessels is safe and effective, even in insulin-dependent patients.
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.forename: José A
authors.initials: JA
authors.lastname: Gómez-Hospital
authors.forename: Marcelo
authors.initials: M
authors.lastname: Sanmartín
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D003627:Data Interpretation, Statistical; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000401:mortality / Q000628:therapy*; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D014463:Ultrasonography; D014741:Video Recording
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus