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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.
Bulletin de l'Académie nationale de médecine 02/2005; 189(2):249-56. · 0.16 Impact Factor