Revascularization of diabetic patients: are drug-eluting stents the solution?

Restenosis and need of repeat revascularization as well as major adverse cardiac events (MACE) are all significantly increased after coronary stenting in patients with diabetes compared to non-diabetic patients. The potential clinical benefit of drug-eluting stents (DES) in this cohort is currently under definition. Both Cypher and Taxus stents in randomized clinical trials and real world post-approval registries appear to be effective with a substantial reduction in MACE and target lesion revascularization compared to control patients. However, despite stability of target lesion revascularization obtained with DES, diabetes continues to be associated with a significant increase in MACE at mid- and long-term follow-up. These data emphasize the role of a fully integrated medical, glycemic and device treatment for optimal outcome in diabetes. In order to develop new guidelines for diabetic treatment, prospective and randomized studies comparing DES with surgical revascularization in three-vessel and/or left main disease are ongoing. Despite significant amelioration obtained with DES the diabetic population remains an unmet need, requiring further basic and clinical research.