Rapport benefice/risque des endoprotheses coronaires pharmaco-actives. 2ème partie : analyse dans la population diabétique

The diabetic patient is at high risk of coronary heart disease. He/she can benefit of revascularisation procedures,
even if he/she is exposed to a higher incidence of complications
after a coronary artery bypass graft or a percutaneous transluminal coronary angioplasty. The use of drug-eluting stents — paclitaxel (PES) or sirolimus (SES) — dramatically reduces the risk of restenosis as compared to bare-metal stents; nevertheless, the rate of restenosis remains almost double in diabetic patients compared to that observed in non-diabetic subjects. However, the risk of (very) late thrombosis is higher with drug-eluting stents than with bare-metal stents, in the diabetic
population as in the non-diabetic population. Altogether, among diabetic patients, the incidence of major cardiovascular events is significantly reduced with drug-eluting stents. This global clinical benefit essentially results from a diminution of revascularisation procedures rather than from a reduction of myocardial infarcts or cardiovascular deaths. Comparison between SES and PES gives discordant results. Indeed, while the loss of intra-stent lumen is more important with PES than with SES, PES are associated with a lower rate of major cardiovascular
events than SES. Efficacious antiplatelet therapy in the long run is mandatory in all diabetic patients treated with drug-eluting stents