Diabetes Watch Blog: Stenting Options In Diabetics
Head-to-head studies have shown that drug-eluting stents infused with medicine to keep the artery from re-narrowing perform better than bare metal stents in patients treated for coronary artery disease. A 2005 study by Dr. Charles Simonton showed similar outcomes in the general population of patients for the two types of medicated stents currently being used in the United States.
Dr. Simonton and the STENT Group of eight coronary intervention centers have examined how the sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) performed in patients with diabetes. The STENT Group is the first prospective, consecutive, multi-center registry for drug-eluting stents in the U.S., which began enrollment in May 2003. More than 80 percent of all interventions are enrolled at the eight sites, with nine-month clinical follow-up achieved in 94 percent of patients.
A total of 1,680 diabetic patients undergoing either pure PES or pure SES procedures (i.e. no other vessels treated with other devices) were enrolled and completed nine-month follow up. Of the 498 insulin-treated diabetic patients, 235 received PES and 263 received SES. Of the remaining non-insulin-treated diabetic patients (1,182 pts), 570 received PES and 612 received SES. While PES-treated patients more frequently had high-risk or longer lesions and vessels smaller than 3 mm, baseline assessments were otherwise similar for both groups.
Nine-month follow up showed that the PES and SES stents resulted in similar outcomes in all of the diabetic patients. Major adverse cardiac events (MACE) were low, but researchers noticed for insulin-treated diabetes, PES treatment resulted in fewer adverse event rates than SES treatment. Specifically, PES was associated with reduced rates of death (2.1 percent vs. 5.7 percent), heart attack (1.3 percent vs. 1.9 percent), restenosis or renarrowing of the artery (3.4 percent vs. 4.2 percent) and overall MACE (5.9 percent vs. 10.6 percent). After adjusting for the differences in the two stent groups, the relative chance of a MACE event in the insulin-treated group was 52 percent lower for the PES patients than the SES patients. All differences between PES and SES were not statistically significant.
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Type-2 diabetes is the most common form of diabetes, accounting for 90% of cases diabetes. This disease affects nearly 17 million Americans and is the seventh leading cause of death in the United States. Even though 17 million Americans have type-2 diabetes only half of these people are aware that they have diabetes. The death rate in patients with diabetes may be up to 11 times higher than in persons without the disease. The occurrence of diabetes in persons 45 to 64 years of age is 7 percent, but the proportion increases significantly in persons 65 years of age or older. Type-2 diabetes accounts for more than 90% of all diabetes worldwide.
Diabetes Watch Blog: Stenting Options In Diabetics
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