CORRESPONDENCE: LETTER TO THE EDITOR
Endothelialization and Late Stent Thrombosis in Diabetics
Hideaki Kaneda, MD, PhD*
* Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Tokyo 105-8470, Japan (Email: hdkaneda{at}gmail.com).
With great interest, I read the article by Brar et al. (1) that determined whether long-term clinical outcomes differed between bare-metal stents and drug-eluting stents by duration of clopidogrel use among diabetic patients. The investigators stated, "an in vitro study shows that rapamycin does not seem to impair smooth muscle migration to the same degree in a hyperglycemic environment compared with an euglycemic environment, which might account for the greater late loss observed in diabetic patients. This might lead to higher rates of endothelialization and thus lower rates of late stent thrombosis in diabetic patients." However, as stated in the editorial as well as previous studies (2–4), diabetes is a patient subgroup that is at the highest risk of stent thrombosis. Higher rates of endothelialization do not simply translate into lower rates of late stent thrombosis, at least in diabetics, and do not seem to explain the difference between this and previous studies as well.
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1. Brar SS, Kim J, Brar SK, et al. Long-term outcomes by clopidogrel duration and stent type in a diabetic population with de novo coronary artery lesions J Am Coll Cardiol 2008;51:2220-2227.[Abstract/Free Full Text]2. Choi SH, Prasad A, Tsimikas S. The evolution of thienopyridine therapy clopidogrel duration, diabetes, and drug-eluting stents J Am Coll Cardiol 2008;51:2228-2229.[Free Full Text] 3. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents JAMA 2005;293:2126-2130.[Abstract/Free Full Text] 4. Machecourt J, Danchin N, Lablanche JM, et al. Risk factors for stent thrombosis after implantation of sirolimus-eluting stents in diabetic and nondiabetic patients: the EVASTENT Matched-Cohort Registry J Am Coll Cardiol 2007;50:501-508.[Abstract/Free Full Text]
Related Article
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- Somjot S. Brar, Albert Yuh-Jer Shen, Vicken Aharonian, Prakash Mansukhani, and John Kim
J. Am. Coll. Cardiol. 2008 52: 2213.
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