Sirolimus stent best for diabetic heart disease

NEW YORK (Reuters Health) - As a treatment for heart disease in diabetics, stents that release sirolimus, an immune-suppressing drug, are more effective than those that release paclitaxel, a cancer-fighting drug, for keeping coronary arteries open after angioplasty, new research shows.

A stent is a tiny hollow tube that is placed in the coronary arteries to maintain blood flow after the blood vessel has been dilated with angioplasty. In the past, stents were simply made out of metal and did not release any drugs. In recent years, there has been evidence that the so-called "drug-eluting" stents are superior to bare metal ones.

The optimal drug-eluting stent for diabetic patients has been unclear, lead author Dr. Fabrizio Tomai, from the European Hospital in Rome, and colleagues note in the journal Diabetes Care.

Comparing paclitaxel with sirolimus stents has been difficult since there are so many individual patient variables that contribute to blockage after stent placement. In the present study, the researchers addressed this problem by comparing paclitaxel and sirolimus stents directly in the same diabetic patient.

The study enrolled 60 patients with two or more blockages in different segments of the coronary arteries. Overall, 60 blockages were successfully treated with paclitaxel stents and 60 with sirolimus stents, the report shows.

At 8-month follow-up, X-ray analysis revealed that the arteries treated with sirolimus stents showed less narrowing than those treated with paclitaxel stents. In short, significant narrowing was over twice as likely to occur with paclitaxel stents than with sirolimus ones.

Further research is needed to determine if the better X-ray results achieved with sirolimus stents actually translate into long-term clinical benefits, the authors conclude.

SOURCE: Diabetes Care, January 2008.