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. The authors do agree that there were some limitations in the studies including the type of diabetics, chronicity of diabetes and types of medications administered after stenting (2).
Nevertheless, for diabetics this should be great news. Coronary bypass surgery does have some benefits but given the choice of treatment, any reasonable patient would opt for a percutaneous stenting procedure instead of opening the chest. Now diabetics can also opt for this limited invasive option and be home the same day of the procedure.
Claessen B, et al "Long-term clinical outcomes of percutaneous coronary intervention for chronic total occlusions in patients with versus without diabetes mellitus" Am J Cardiol 2011; DOI: 10.1016/j.amjcard.2011.05.021. http://www.ncbi.nlm.nih.gov/pubmed?term=claessen%20B
Minha S, et al "A comparative analysis of major clinical outcomes using drug-eluting stents versus bare metal stents in diabetic versus nondiabetic patients".
Catheter Cardiovasc Interv. 2011 Jul 29. doi: 10.1002/ccd.23062. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/21805561
Reviewed August 15, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith