PRESTO! No Change for Diabetics

Abstract

Improved techniques in percutaneous intervention did not eliminate the consequences that affect diabetic patients undergoing such procedures in the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial. The study, reported in this week’s issue of the journal Circulation ( Circulation . 2004;109:476–480), compared the outcomes of the 2694 diabetic patients and the 8798 nondiabetic patients in the multicenter trials. The PRESTO study itself, designed to evaluate the effect of tranilast on percutaneous intervention outcomes, found that the drug had no effect. In this secondary analysis, diabetic patients were older, were more likely to be female, had more congestive heart failure and hypertension, and were more likely to have undergone coronary artery bypass grafting and to have unstable angina. Their body mass index was higher than that of the nondiabetic patients, and they had a lower ejection fraction. Success rates of the procedures were similar between the two groups. Diabetes was independently associated with death at 9 months, an increased likelihood of target-vessel revascularization, and the composite end point of death/myocardial infarction and target-vessel revascularization. The authors wrote, “Despite advances in interventional techniques, diabetes remains a significant independent predictor of adverse events in the intermediate term after PCI [percutaneous intervention]. . . . There are multiple possible explanations for this observation, including the known impairment of fibrinolysis and increased platelet aggregability, which may contribute …