Should Drug-Eluting Stents Change the Selection for Revascularization in Diabetic Patients With Multivessel Disease?
Because the opportunity for altering the outcome for patients undergoing percutaneous intervention by use of drug-eluting stents is related to the ability to reduce restenosis, we should first understand the magnitude of restenosis reduction that is being achieved. It is also important to understand how a reduction in restenosis will affect the hard end points of death and myocardial infarction in such patients. In the controlled randomized trials, the reduction in reintervention was very large. In the SIRIUS trial of sirolimus-eluting stents, 279 patients with diabetes mellitus were randomized. At 9 months, target lesion revascularization was reduced from 22.3% with bare-metal stents to 6.9% with drug-eluting stents, and major adverse cardiac events were reduced from 25% to 9.2%.39 However, one must remember that these trials mandated an angiographic follow-up, and therefore, revascularization was driven not only by clinical necessity but also by the angiographic appearance of narrowi
