Differential Drug-eluting Stent Effects in Patients with Diabetes – Bench-to-bedside Evidence for Neointimal Suppression and Restenosis Reduction

Abstract

Patients with diabetes are particularly prone to coronary atherosclerosis, and the presence of diabetes increases the annual mortality risk in patients with proven coronary artery disease. Patients with diabetes also have an increased risk of restenosis following both balloon angioplasty and bare-metal stent (BMS) placement, due to differences in cellular proliferative signalling and a consequent accentuated neointimal response compared with that seen in patients without diabetes. Drug-eluting stents (DES) generally moderate this neointimal response and reduce restenosis in patients both with and without diabetes, without increasing the safety risk compared with BMS. However, it is unknown whether the different antiproliferative agents used in DES influence their comparative safety and efficacy. This article summarises recent peer-reviewed data from a range of molecular, cellular, imaging and clinical studies to provide an integrated bench-to-bedside perspective on the relative effects of commercially available DES in patients with diabetes versus patients without diabetes.