[Benefit-risk ratio of coronary drug-eluting stents: 2nd part: evaluation in the diabetic population].
The diabetic patient is at high risk of coronary heart disease. He/she can benefit of revascularisation procedures, even if he/she is exposed to a higher incidence of complications after a coronary artery bypass graft or a percutaneous transluminal coronary angioplasty. The use of drug-eluting stents--paclitaxel (PES) or sirolimus (SES)--dramatically reduces the risk of restenosis as compared to bare-metal stents; nevertheless, the rate of restenosis remains almost double in diabetic patients compared to that observed in non-diabetic subjects. However, the risk of (very) late thrombosis is higher with drug-eluting stents than with bare-metal stents, in the diabetic population as in the non-diabetic population. Altogether, among diabetic patients, the incidence of major cardiovascular events is significantly reduced with drug-eluting stents. This global clinical benefit essentially results from a diminution of revascularisation procedures rather than from a reduction of myocardial infarcts or cardiovascular deaths. Comparison between SES and PES gives discordant results. Indeed, while the loss of intra-stent lumen is more important with PES than with SES, PES are associated with a lower rate of major cardiovascular events than SES. Efficacious antiplatelet therapy in the long run is mandatory in all diabetic patients treated with drug-eluting stents.
Nyssen
A
A
Etudiante, Université de Liège.
Legrand
V
V
Scheen
A J
AJ
D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D017239:Paclitaxel / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology; D018570:Risk Assessment; D020123:Sirolimus / Q000008:administration & dosage; D013927:Thrombosis / Q000209:etiology
D017239:Paclitaxel; D020123:Sirolimus