Editorials

Drug eluting stents for patients with diabetes

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5828 (Published 12 September 2012) Cite this as: BMJ 2012;345:e5828
  1. Koon-Hou Mak, cardiologist
  1. 1Gleneagles Medical Centre, Singapore 258499
  1. makheart{at}gmail.com

The role of coronary revascularisation versus medical treatment needs clarification

In general, drug eluting stents have improved outcomes after percutaneous coronary intervention (PCI).1 However, more deaths were reported in patients with diabetes who received drug eluting stents than in those who received bare metal stents.2 For several years, coronary artery bypass grafting has been the main method of coronary revascularisation in patients with diabetes and multivessel disease because of better survival and lower need for repeat revascularisation than with stenting.3 The lower success rate and higher complication rate of coronary stenting procedures in patients with diabetes may be attributed to several factors—complex coronary anatomy, diffuse and extensive disease, presence of comorbidities, and problematic vascular access. Several mechanistic and cellular pathways accentuate inflammation, and oxidative stress may account for these poorer outcomes in patients with diabetes.

However, a network meta-analysis recently reported that drug eluting stents were safe and prevented target vessel revascularisation in patients with and without diabetes who were given dual antiplatelet treatment for more than six months.4 Taking the evidence a step further, in a linked research paper (doi:10.1136/bmj.e5170), Bangalore and colleagues explored the relative differences in outcomes for …

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