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Advanced Cardiac Specialists
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RESEARCH NARROWS GAP BETWEEN DIABETIC AND
NON-DIABETIC PATIENT OUTCOMES
New Study Presented at The Society for Cardiovascular
Angiography & Interventions Shows Improved Survival with Use of
Drug-Eluting Stents in Diabetic Patients
Phoenix (May 9, 2006) -
It is estimated that nearly one in four of all coronary stent procedures
(called PCI or percutaneous coronary intervention) in the United States are
performed in diabetics. Despite
significant advances in the invasive treatment of coronary artery disease,
diabetics have continued to be at a distinct disadvantage, with lower procedure
success rates, more frequent re-narrowing of the stent, and greater long-term
mortality.
A
study selected for presentation at the Annual Scientific Meeting of the Society
for Cardiovascular Angiography & Interventions (SCA&I) in Chicago from
May 10-13, 2006, suggests encouraging results with the use of drug-eluting
stents (DES) in diabetics with coronary heart disease. A DES is a standard coronary stent coated on
the outside with a thin polymer-containing medication that is gradually
“eluted” into the local area where the stent is placed, and can prevent or
reduce the formation of scar tissue at the site of stent implantation.
The study retrospectively
analyzed long-term clinical outcomes in 809 diabetic patients, 442 of whom
received DES and 367 received the standard “bare metal” stent (BMS). Diabetic patients who received DES were
sicker and had more complex angiographic characteristics, including smaller
coronary artery size. Despite that
handicap, re-establishment of blood flow was superior when DES were used. Although this did not appear to impact
in-hospital outcomes, in the long term, diabetic patients treated with DES
showed a greater degree of heart muscle salvage, more significant improvement
in heart function and improved survival at the end of the first year.
Discussing
the rationale for the remarkably improved clinical outcomes obtained with DES
in diabetics, the study proposes that the polymer-based focal drug
elution from the stent addresses the focal inflammatory response
provoked by stent deployment, more effectively than the standard bare metal
coronary stent. The anti-proliferative
nature of the drug used to coat the stent markedly reduces the regrowth of tissue
within the atherosclerotic artery (called “neointimal hyperplasia”), a
phenomenon that is markedly exaggerated in diabetic arteries.
The study was conducted by Advanced Cardiac Specialists’ Department of Cardiovascular Research. The authors of this retrospective study are Robert M. Siegel, MD, Medical Director, Advanced Cardiac Specialists, Ambika Bhaskaran, MD, Medical Director, Cardiovascular Research at Advanced Cardiac Specialists and their colleagues.