Studies with Drug Eluting Stents

Drug-eluting stents are particularly appealing for patients with diabetes mellitus because they offer a solution to the most crucial problem of PCI in this patient subset, restenosis. A recently published meta-analysis of the diabetic patients in randomized studies comparing drug-eluting stents with bare metal stents confirmed that drug-eluting stents confer a similar relative reduction in restenosis in diabetics and in nondiabetics, compared with bare metal stents.72 The same meta-analysis did not reveal any safety issues with respect to the 1-year incidence of death or the composite of death and nonfatal MI. Based on the older studies for PCI in diabetes, it may be anticipated that the reduction in restenosis conferred by drug-eluting stents compared with bare metal stents may confer a survival benefit during longer-term follow-up.

As of this writing, the role of drug-eluting stents in the treatment of multivessel disease in patients with diabetes cannot be judged by evidence-based criteria. Thus far, data from large registries and randomized trials comparing drug-eluting stents with CABG for multivessel disease in diabetics are lacking. A large trial sponsored by the National Institutes of Health addressing this issue, FREEDOM, is underway.

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