Diabetics tend to develop not only severe coronary disease but the disorder is often premature in onset. Despite adequate control of blood sugars, a significant number of diabetics develop coronary disease. While preventive measures such as lifestyle changes, exercise, discontinuation of smoking and healthy diet have helped, this is by no means a guarantee that coronary artery disease will not occur.
For the past two decades, there was general consensus that diabetics with coronary disease were better served with open-heart surgery because the size of their coronary vessels did not make them amenable to percutaneous interventions. Clinical trials done in the past showed that stenting was not always a good option. However, in the last two decades, there has been a tremendous improvement in percutaneous techniques and stents to treat a variety of vascular disorders including coronary artery disease.
Now there is evidence showing that the long-term outcome of diabetic patients following percutaneous coronary intervention is significantly improved. This is great news because open-heart surgery is fraught with numerous complications with no guarantee of long-term success. The recent study by Roxana Mehran of the Cardiovascular Research Foundation in New York reveals that at a median follow up of three years, the mortality rate after a successful stenting procedure was significantly better for diabetics than if no stent has been used. More important, the patient who had stenting done also required significantly less need for open-heart surgery. The study was just published in the American Journal of Cardiology (1).
Until this study came along, there were fewer data on long-term results of stenting in diabetics. It had always been assumed that surgery was a better option for treatment of coronary disease.
The study revealed that the best results were obtained when drug-eluting stents were used instead of bare stents. More importantly, regardless of the status of diabetes, the rate of stent occlusion was not increased when drug-eluting stents were used.