Stents for Diabetes?

Diabetes patients may benefit more from drug eluting stents than bare metal stents

(RxWiki News) Narrowed blood vessels can be treated using stents - a sort of scaffolding that widens the vessels. There are different types of stents, each working slightly differently. So, which type works best in diabetes patients?

Drug eluting stents (stents that carry drugs) appeared to be safer and more effective than bare metal stents (stents that do not carry drugs), according to a large study.

"Get treated for heart-related problems if you have diabetes."

People with diabetes are at greater risk of heart problems than those without diabetes. According to Sripal Bangalore, MD, of New York University School of Medicine, and colleagues, diabetes also has been associated with worse outcomes after treatment with bare metal or drug eluting stents.

While some drug eluting stents have been shown to lower the risk of restenosis (recurrence of narrowed vessels), researchers are still unclear about whether these stents work well in people with diabetes.

Dr. Bangalore and colleagues set out to study the relative safety and effectiveness of a number of drug eluting stents compared to bare metal stents among diabetes patients.

Compared to bare metal stents, drug eluting stents worked better at improving blood flow. More specifically, drug eluting stents were associated with a 37 percent to 69 percent reduction in the rate of target vessel revascularization.

In their study, the researchers compared four drug eluting stents against each other and against bare metal stents. Each drug eluting stent carried a different drug: sirolimus, paclitaxel, everolimus or zotarolimus.

The size of this reduction was different for each drug eluting stent. Sirolimus eluting stents worked much better than zotarolimus eluting stents but worked similarly well to paclitaxel eluting stents or everolimus eluting stents.

Everolimus eluting stents were more effective than paclitaxel eluting stents or zotarolimus eluting stents.

Compared to all other stents, there was an 87 percent chance that everolimus eluting senates would have the lowest rate of target vessel revascularization.

When it came to the risk of thrombosis (blood clot), there was a 62 percent chance that everolimus eluting stents were the safest type of stent.

Compared with bare metal stents, there was no increased risk of death with any drug eluting stents. In fact, drug eluting stents were not associated with any increased risks, compared to bare metal stents.

"Among patients with diabetes treated with coronary stents, all currently available drug eluting stents were efficacious without compromising safety, compared with bare metal stents," the authors concluded.

In other words, all drug eluting stents reduced the risk of target vessel revascularization without increasing any other risks.

For their study, Dr. Bangalore and colleagues looked at 42 past studies with 22,844 patient years of follow-up.

Dr. Bangalore disclosed being on the advisory boards of Boehringer Ingelheim and Daiichi Sankyo. Co-author Donald E. Cutlip, MD, was the principal investigator on the Medtronic EDUCATE trial.

Their study was published August 10 in BMJ.

Review Date: 
August 19, 2012