Percutaneous coronary revascularization of diabetic patients in the era of drug-eluting stents.

Patients with diabetes have worse clinical outcomes following both surgical revascularization and percutaneous coronary intervention (PCI). Although coronary stenting has improved late outcomes (versus balloon angioplasty) following PCI, both angiographic restenosis and the requirement for repeat revascularization are increased in diabetics versus nondiabetics and limit the durability of PCI compared with surgery. Polymer-based drug-eluting stents (DES) have markedly reduced late coronary lumen loss and angiographic restenosis as well as the need for repeat revascularization when compared with conventional (non-drug-eluting) coronary stent deployment. Specifically, the CYPHER sirolimus-eluting stent (Cordis Cardiology, Miami Lakes, FL) has demonstrated durable clinical and angiographic benefit for diabetic patients in both randomized clinical trials and postmarket surveillance registries. Data on the more recently approved paclitaxel-eluting TAXUS (Boston Scientific, Natick, MA) stent suggest similar efficacy for the treatment of diabetic patients. By markedly reducing restenosis, DES significantly improve or eliminate the major limitation of conventional stenting/PCI in diabetic patients. The advent of DES promises a paradigm shift from surgical revascularization in diabetic patients (especially those with multivessel disease) to PCI. Nevertheless, continued improvement in DES delivery as well as optimal adjunctive pharmacotherapy and control of hyperglycemia will be required to achieve the best clinical outcomes following PCI with DES in patients with diabetes.