Introduction: The Evolving Landscape of Percutaneous Coronary Intervention in Diabetes
The management of coronary artery disease (CAD) in patients with diabetes mellitus remains one of the most formidable challenges in interventional cardiology. Historically, patients with diabetes have faced significantly worse outcomes following percutaneous coronary intervention (PCI) compared to their non-diabetic counterparts. These outcomes include higher rates of myocardial infarction, target lesion revascularization, and the most feared complications of the procedure: stent failure.
Stent failure, manifested as either in-stent restenosis (ISR) or stent thrombosis (ST), represents a clinical failure of the local mechanical and pharmacological intervention. While the advent of second-generation drug-eluting stents (DES)—featuring thinner struts, more biocompatible polymers, and more effective limus-based antiproliferative drugs—has dramatically reduced these risks for the general population, the extent to which they have mitigated the ‘diabetes tax’ remains a subject of intense investigation. Until recently, large-scale data specifically comparing the long-term failure rates of second-generation DES between Type 1 and Type 2 diabetes versus non-diabetic populations have been limited. This analysis of the SWEDEHEART registry provides much-needed clarity on the clinical burden of stent failure in this high-risk population.
