NEW YORK (Reuters Health) – Balloon angioplasty, drug-eluting stents, and bare metal stents appear to be equally effective at reducing death or myocardial infarction (MI) over a year’s time in diabetic patients, according to a new study.

But drug-eluting stents were the most effective at reducing need for repeat revascularization, the investigators reported online June 2 in Diabetes Care.

Previous research has shown that diabetic patients have higher risks for late thrombosis of coronary stents (see Reuters Health stories of February 3, 2010 and May 22, 2009). In fact, a study published last year suggested that optimal medical therapy may be as effective as surgery in these patients (see Reuters Health story of June 8, 2009).

With a growing number of diabetics undergoing percutaneous coronary interventions (PCI), Dr. Faith Selzer at the University of Pittsburgh and colleagues analyzed data on diabetic patients from the National Heart, Lung, and Blood Institute’s 1985-1986 Percutaneous Transluminal Coronary Angioplasty Registry (balloon era) and the 1997-2006 Dynamic Registry (bare metal stent and drug-eluting stent era).

Overall, they had information on 1846 patients: 459 treated with balloon angioplasty, 795 with bare metal stents and 592 with drug-eluting stents. The mean age was early 60s, and roughly 40% were female.

The authors note that patients who received stents were more likely to receive recommended medications at discharge (e.g., aspirin, angiotensin-converting enzyme inhibitors, beta blockers, lipid lowering agents and antiplatelet agents).

The overall 1-year incidence of death or MI was 16% for balloon angioplasty, 13% for bare metal stents and 10% for drug-eluting stents (p = 0.01). However, on multivariable analysis adjusted for baseline characteristics and discharge use of cardiac medications, there was no significant difference among the groups.

The rates of repeat PCI or bypass surgery in 1 year were 30% for balloon angioplasty, 20% for bare metal stents and 13% for drug-eluting stents (p < 0.001). The lower risk with drug-eluting stents persisted on multivariable analysis. The authors note that their study is limited by lack of information, such as diabetes duration, extent of glucose control, or medication dosages. And since their analysis involved registry data, there may be residual confounding. The death/MI benefit observed with drug-eluting stents versus balloon angiography “may well be due to greater use of pharmacotherapy,” the authors conclude. Reference:
http://care.diabetesjournals.org/content/early/2010/05/29/dc10-0247.abstract

Diabetes Care 2010.