A randomized comparison of sirolimus‐eluting versus bare metal stents in the treatment of diabetic patients with native coronary artery lesions: The DECODE study

Abstract

In diabetics, the mean 6-month in-stent LLL was significantly smaller, and 12-month MACE rate significantly lower, after myocardial revascularization with SES than with BMS.

The Relationship Between Coronary Artery Disease and Undiagnosed Glucose Metabolism Disorders in Patients who Have Undergone Angiography

“…The DECODE study has shown that the risk of developing CAD increases as a result of chronic hyperglycemia. The results of these two studies support the findings of our study (13). According to the TURDEP-2 study, 7.5% of the Turkish population (approximately 5.5 million people) has undiagnosed DM (8).…”

Immune therapy for age-related diseases

“…However, no clinical studies have been reported that show that drugs that inhibit vascular inflammation prevent atherosclerosis in healthy humans, although recently published studies suggest that treatment of patients with drugs that inhibit inflammatory atherosclerosis can be effective in secondary prevention of atherosclerotic vascular events [45]. For example, immunosuppressive drugs such as rapamycin can delay coronary arterial restenosis after angioplasty [45]. Furthermore, a recently published multicenter study of 17 000 healthy individuals with low levels of LDL but with high levels of the inflammatory marker, C-reactive protein, treated with the cholesterol-lowering drug rosuvastatin, showed decreased atherosclerotic complications [34].…”

“…Increased levels of C-reactive protein, a marker of systemic inflammation, are known to be a risk factor for heart attacks and strokes [32]. However, no clinical studies have been reported that show that drugs that inhibit vascular inflammation prevent atherosclerosis in healthy humans, although recently published studies suggest that treatment of patients with drugs that inhibit inflammatory atherosclerosis can be effective in secondary prevention of atherosclerotic vascular events [45]. For example, immunosuppressive drugs such as rapamycin can delay coronary arterial restenosis after angioplasty [45].…”

Coronary Revascularization in Diabetics: The Background for an Optimal Choice

“…The absolute reduction in repeat revascularization was more pronounced in diabetic than non-diabetic patients, due to the higher baseline risk of restenosis, so the use of DES should be strongly recommended when PCI is the revascularization choice in diabetic patients. The diabetics in TAXUS IV (Dangas 2004), SIRIUS (the Sirolimus-Eluting Stent in de Novo Native Coronary Lesions trial) (Moses 2003), DECODE (Chan 2008), and DIABETES trials had single digit target lesion revascularization rates (7.8%) with DES versus 24.7% with bare-metal stents (Hillegass 2008). Although a recent meta-analysis of four trials suggested an increased risk of death with sirolimus-eluting stent compared to bare-metal stents in diabetic patients (Spaulding 2007), this finding was not confirmed in a larger analysis of 14 trials (Kastrati 2007).…”