Diabetes can lead to complications that reduce blood flow, putting patients at risk of heart attack. To improve blood flow, patients may go through a procedure called angioplasty. But not all angioplasties are created equal.
In angioplasty, a small mesh tube called a stent is placed in a narrowed or blocked artery to improve blood flow. Some stents are coated with medicine. These are called drug-eluting stents.
According to a recent study, diabetes patients undergoing their first angioplasty may have worse long-term rates of death, a higher risk of a second heart attack and a higher risk of blood clots forming on a stent, compared to patients without diabetes.
Diabetes patients also appeared to have an increased risk of a second procedure to improve blood flow. However, that risk seemed to be reduced in patients who received drug-eluting stents.
In their study, Giuseppe de Luca, MD, of Eastern Piedmont University in Italy, and colleagues wanted to see how diabetes may affect the long-term outcomes of patients undergoing their first angioplasty. The researchers compared patients receiving drug-eluting stents and bare metal stents.
Unlike drug-eluting stents, bare metal stents have no medicinal coating.
The study included 6,298 heart attack patients undergoing their first angioplasty. A total of 972 patients (15.4 percent) had diabetes. Diabetes patients were older, more likely to be female, had higher rates of high blood pressure and high cholesterol and longer periods of reduced blood flow.
After 1,201 days of follow-up, results showed:
- 19.1 percent rate of death among diabetes patients, compared to 7.4 percent among those without diabetes.
- 10.4 percent rate of reinfarction (heart attack after a previous heart attack) among diabetes patients, compared to 7.5 percent among those without diabetes.
- 7.6 percent rate of stent thrombosis (formation of blood clots on stents) among diabetes patients, compared to 4.8 percent among those without diabetes.
- 18.6 percent rate of repeat target vessel revascularization (repeat revascularization procedure) among diabetes patients, compared to 15.1 percent among those without diabetes.
According to the authors, these findings suggest that diabetes is associated with worse long-term rates of death, reinfarction and stent thrombosis in patients undergoing a first angioplasty with either drug-eluting stents or bare metal stents.
"[Drug-eluting stent] implantation, however, does mitigate the known deleterious effect of diabetes on target vessel revascularization after bare metal stent," the authors concluded.
The study was published December 28 in Diabetes Care, a journal of the American Diabetes Association.