Drug-Laced Stents Keep Heart Arteries Open

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Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients, by A. Dibra and colleagues. N Engl J Med 353:663–670, 2005.

What is the problem and what is known about it so far?

People with diabetes are very likely to get coronary artery disease (disease of the blood vessels of the heart). When heart arteries are diseased, they narrow. When this happens, a person may feel chest pain or suffer a heart attack.

To keep arteries open, small spring-like devices called stents are often placed in heart arteries to keep them open. But often, the arteries narrow again.

Newer types of stents slowly release a drug (medicine) that slows or prevents arteries from narrowing again. But little is known whether one type of medicine-releasing stent is better than another.

Why did the researchers do this particular study?

They wanted to compare the effects of two different stents: one that releases paclitaxel and one that releases sirolimus.

Who was studied?

The study included 250 people with diabetes and disease of blood vessels of the heart. All participants were treated at two hospitals in Germany.

Half the patients received the paclitaxel-containing stent, while the other half received the sirolimus-containing stent.

How was the study done?

All the participants had heart and imaging tests to measure the narrowness of their blood vessels. Blood tests were done to see how they were controlling their diabetes. Participants were contacted by telephone about 30 days after the stent was placed to see how they were doing.

What did the researchers find?

More blood vessels remained open among the participants who received the sirolimus-containing stent than the paclitaxel-containing stent. About 16.5% of those who received the paclitaxel-containing stent were found to have narrowed blood vessels again, compared to 6.9% of those who received the sirolimus-containing stent.

What were the limitations of the study?

The researchers' prime goal was to measure narrowing of heart blood vessels. Other ways of measuring blood-vessel narrowing may not have been considered. Other outcomes of the surgery may not have been measured.

What are the implications of the study?

In people with diabetes, stents containing sirolimus may reduce the chance their heart blood vessels will narrow again.