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Drug eluting stents in patients with diabetes

BMJ 2008; 337 doi: (Published 31 August 2008) Cite this as: BMJ 2008;337:a1359
  1. Pierfrancesco Agostoni, interventional cardiologist,
  2. Frank Van den Branden, departmental director
  1. 1Antwerp Cardiovascular Institute Middelheim, Ziekenhuis Netwerk Antwerpen, 2020 Antwerp, Belgium
  1. agostonipf{at}

    Long term aspirin and clopidogrel are key to improving safety

    A quarter of people who need myocardial revascularisation have diabetes. After coronary artery bypass surgery and percutaneous coronary interventions, these patients have worse outcomes than those without diabetes.1 They have more extensive coronary atherosclerosis, accelerated plaque progression, an increased rate of restenosis after percutaneous coronary intervention, and faster progression of bypass graft disease after bypass surgery.2 Randomised trials have indicated that—especially in terms of repeated revascularisation procedures—coronary artery bypass surgery is more effective than percutaneous coronary intervention with bare metal stents in patients with diabetes, particularly in multivessel coronary disease.1 In the linked meta-analysis (doi: 10.1136/bmj.a1331), Stettler and colleagues compare the effectiveness and safety of sirolimus eluting stents, paclitaxel eluting stents, and bare metal stents in people with and without diabetes.3

    Because of local pharmacological inhibition of restenosis, drug eluting stents reduce the need for repeated revascularisation compared with bare metal stents. It was hoped that these stents would be as effective as coronary artery bypass surgery, even in patients with diabetes. However, in the past two years there …

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