Type 1 and type 2 diabetes significantly increased the risk of second-generation DES stent failure compared to non-diabetics (HR 2.28, 95% CI 1.97-2.65 and HR 1.35, 95% CI 1.27-1.44).
Observational (n=160,523)
Yes
Does type 1 or type 2 diabetes increase the risk of stent failure in patients receiving second-generation DES compared to non-diabetic individuals?
Patients with type 1 diabetes have a substantially higher risk of second-generation DES failure compared to those with type 2 diabetes or no diabetes.
Effect estimate: HR 2.28 (type 1), HR 1.35 (type 2) (95% CI 1.97-2.65 (type 1), 1.27-1.44 (type 2))
Abstract Background The relationship between coronary stent failure and diabetes in patients treated with second-generation drug-eluting stents (DES) is not as well understood as it was in the eras of balloon angioplasty, bare-metal stents, and first-generation DES. Purpose To evaluate the risk of stent failure in patients with type 1 and type 2 diabetes compared to non-diabetic individuals after implantation of second-generation DES. Methods This nationwide observational study included all patients in Sweden who received second-generation DES between 2010 and 2020. Data were obtained from seven Swedish national registers. Patients were categorized into three groups: non-diabetes (reference group), type 1 diabetes, and type 2 diabetes. The primary endpoint was stent failure, defined as in-stent restenosis and stent thrombosis. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated by Cox regression models. Sensitivity analyses were performed to address missing data in covariates and account for death as a competing risk. Results The study included 160,523 patients: 114,740 without diabetes, 2,406 with type 1 diabetes, and 43,377 with type 2 diabetes. Seventy-one percent were male. Over a mean follow-up of 4.5 years, 5510 stent failure events occurred (Figure 1). The fully adjusted HR for stent failure was 2.28 (95% CI 1.97–2.65) for type 1 diabetes and 1.35 (95% CI 1.27–1.44) for type 2 diabetes, compared to non-diabetes patients (FIgure 2). These associations remained unchanged after adjusting for glycemic control. Sensitivity analyses confirmed the robustness of the findings, with both in-stent restenosis and stent thrombosis contributing to the increased risk. The risk of stent failure in type 1 diabetes was significantly higher than in type 2 diabetes HR 1.67 (95% CI 1.47–1.95). Additionally, major adverse cardiovascular events were more common in type 1 diabetes HR 1.70 (95% CI 1.58–1.82) and type 2 diabetes HR 1.08 (95% CI 1.08–1.11), compared to patients without diabetes. Conclusion We observed a significantly higher risk of second-generation DES stent failure in individuals with type 1 diabetes followed by those with type 2 diabetes, compared to non-diabetic individuals. This elevated risk was attributed to both in-stent restenosis and stent thrombosis.Survival curves for stent failure Main results table
Santos-Pardo et al. (2025) conducted an observational in Coronary artery disease requiring second-generation DES (n=160,523). Type 1 and Type 2 diabetes vs. Non-diabetes was evaluated on Stent failure, defined as in-stent restenosis and stent thrombosis (HR 2.28 (type 1), HR 1.35 (type 2), 95% CI 1.97-2.65 (type 1), 1.27-1.44 (type 2)). Type 1 and type 2 diabetes significantly increased the risk of second-generation DES stent failure compared to non-diabetics (HR 2.28, 95% CI 1.97-2.65 and HR 1.35, 95% CI 1.27-1.44).