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Influence of drug-eluting stents in the selection of diabetic patients treated by percutaneous coronary intervention

BACKGROUND: Diabetic patients represent a challenge for percutaneous coronary interventions (PCI) due to the high restenosis rates, which limit the use of the procedure in cases prone to recurrences, predisposing patients to incomplete revascularization. Drug-eluting stents (DES) have contributed for a significant improvement of these limitations and may have caused changes in the characteristics of patients treated contemporaneously. Thus, our objective was to compare the profile of diabetic patients treated in two different periods of this decade METHOD: This was a consecutive cohort study including 2,530 diabetic patients who were divided into two groups: group A, 1,309 patients revascularized from 2006 to 2008; and group B, 1,221 patients treated from 2003 to 2005. Only patients using DES not commercially available were excluded RESULTS: DES were more frequently used in group A (23% vs. 9%; P < 0.0001), which has a higher prevalence of insulinrequiring patients (14% vs. 10%; P = 0.0001), chronic renal failure (20% vs. 10.1%; P < 0.0001), B2/C lesions (68% vs. 63%; P = 0.003), total occlusions (17% vs. 10%; P < 0.0001), stent diameter < 2.5 mm (26% vs. 22%; P = 0.01) and stent length > 24 mm (31% vs. 22%; P < 0.0001). Multivessel interventions (12% vs. 6%; P < 0.001) and complete revascularization (65% vs. 59%; P = 0.002) also prevailed in group A. Clinical hospital results were not different between groups CONCLUSION: The greater availability of DES has led to significant changes in the profile of diabetic patients treated currently, expanding the indications for more complex patients and providing a more complete myocardial revascularization.

Cardiovascular diseases; Drug-eluting stents; Diabetes mellitus


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