[Percutaneous coronary intervention in diabetic patients]

Abstract

Diabetic patients represent one-quarter of all patients undergoing percutaneous coronary intervention (PCI). However, ten years ago a clinical alert recommended coronary artery bypass graft surgery for diabetic patients with multivessel disease. Diabetes is a risk factor for death, myocardial infarction and restenosis. The indications of PCI were re-evaluated after the advent of stenting and anti-GPIIbIIa drugs. In high-risk surgical populations such as those with acute coronary syndromes or prior Coronary Artery by pass Graft surgery-(CABG), PCI is a valuable alternative, even with bare metal stents. Stents eluting sirolimus or paclitaxel reduced the restenosis rate by about 80%, without modifying the risk of death or myocardial infarction. The first results of the EVASTENT study, a real-life study involving French patients treated with sirolimus-eluting stents, confirmed the increased rate of stent thrombosis in diabetic patients (2.5% vs 0.9%, p < 0.001). Drug eluting stent (DES) and abciximab give excellent results after PCI in diabetic patients with single-vessel disease. PCI is also promising for patients with multivessel disease but requires further evaluation in randomized trials. Secondary prevention is of paramount importance.