DES in diabetic patients

Aug 31 2008

The issue of using or not using DES in patients with diabetes will be debated between Professor Wijns, who discourages DES and Professor Silber, who feels that they should be used.

Diabetes is increasingly viewed as a coronary artery disease equivalent. A diabetic patient without history of coronary artery disease bears an equivalent risk of fatal or non fatal myocardial infarction as compared with a non-diabetic patient with a previous history of coronary artery disease. In addition, the diabetic patient diagnosed with coronary artery disease bears additional risk due to the frequent association with co-morbidities (i.e. peripheral vascular disease, chronic kidney disease, congestive heart failure, hypertension, dyslipidemia, hypercoagulable and inflammatory status), excessive revascularization rate (due to enhanced intimal hyperplasia, negative remodeling, presence of small vessel/diffuse disease), accelerated pattern of atherosclerosis, worse clinical outcome (increased rate of mortality, myocardial infarction, stroke, TVR/TLR).

Individuals with diabetes mellitus (DM) usually present with accelerated atherosclerosis, more diffuse diseases, concomitant co-morbidities and have an increased risk for restenosis and late mortality when undergoing percutaneous coronary intervention (PCI) as compared to their non-diabetic counterparts.

In patients with DM and CAD, both PCI and coronary artery bypass surgery are treatment options, although it remains to be determined whether one is preferable over the other. However, CABG has been associated with mortality benefit in patients with multivessel disease, while no such effect was observed with bare-metal stenting nor is to be expected from stenting using DES. The majority of studies include subgroups of patients with DM and were not dedicated to patients with DM in particular. The SYNTAX, FREEDOM and CARDIA trial will shed light on these questions at this conference during Hot Line session III (September 02, 2008 - 11:00-12:45).