How Does Diabetes Affect Coronary Stent Success?

 In a nationwide study of about 0.16 million individuals receiving second-generation drug-eluting stents, having type 1 diabetes was linked to a substantially higher risk for stent failure than not having diabetes, whereas type 2 diabetes was associated with a more modestly increased risk.

METHODOLOGY:

• Researchers in Sweden conducted a nationwide observational study to determine the risk for stent failure in patients with diabetes who were referred for percutaneous coronary intervention.
• They analysed data of 160,523 individuals (median age, 68.4 years; 71.3% men) who received second-generation drug-eluting stents between 2010 and 2020, categorised into three groups: 2406 with type 1 diabetes, 43,377 with type 2 diabetes, and 114,740 without diabetes.
• The primary endpoint was defined as stent failure, including in-stent restenosis or stent thrombosis.
• The median follow-up duration of this study was 4.4 years.

TAKEAWAY:

• Compared with individuals without diabetes, patients with type 1 diabetes had a markedly higher risk for stent failure (adjusted hazard ratio [HR], 2.28; P < .001), whereas those with type 2 diabetes had a more modestly increased risk (adjusted HR, 1.35; P < .001).
• Both in-stent restenosis and stent thrombosis contributed to the increased risk for stent failure.
• The highest burden of stent failure occurred in the first months after stent implantation.
• Compared with patients with type 2 diabetes, those with type 1 diabetes had a 67% increased risk for stent failure (HR, 1.67; P < .001).

IN PRACTICE:

"Our results show that people with diabetes, especially type 1 diabetes, have a much higher risk of stent complications. Therefore, it is important to carefully consider how we treat these patients," the lead author said in a related press release.

"We need to continue to investigate how we can improve treatment for patients with diabetes who undergo stent implantation. Our results indicate that there is a need to adapt treatment and follow-up for them," another author added.

SOURCE:

The study was led by Irene Santos-Pardo, Unit of Cardiology, Department of Clinical Science and Education, Karolinska Institutet in Stockholm, Sweden. It was published online on November 27, 2025, in Diabetes Care.

LIMITATIONS:

Multiple drug-eluting stent platforms and antiproliferative drugs were used in the cohort, and their effects on the results remained uncertain. In-stent restenosis and stent thrombosis events were identified during clinically indicated angiography rather than systematic screening. Information about the type and duration of post-procedure antiplatelet therapy was limited. The registry used in this study did not systematically capture prediabetes cases, and laboratory measurements were unavailable for patients without a diagnosis of diabetes.

https://www.medscape.com/viewarticle/how-does-diabetes-affect-coronary-stent-success-2025a1000xlk