National study identifies diabetic-friendly stents

NAGPUR: A study conducted across 46 cities, including Wockhardt Heart Hospital (WHH) in city, has shown that a particular drug eluting stent is superior for patients with diabetes. This stent, the everolimus stent, was found to be superior as compared to the paclitaxel eluting stent in clinical trials comprising 1,830 patients across India. The two stents are coated with different drugs, which are released in the blood of a patient over a period of 90-120 days after angioplasty.
Dr Prashant Jagtap, senior interventional cardiologist at WHH, said that it was the first such single random trial with such a large number of patients. It is also one of the longest studies. A technical paper based on the study was first published in the New England Journal of Medicine.
Dr Jagtap is the co-author of the second paper titled ‘percutaneous coronary intervention in patients with insulin treated and non-insulin treated diabetes mellitus’. The study has been published in JAMA Cardiology in April this year. It said that the study has put to rest a decade old medical controversy on comparative superiority of the stents in diabetic patients. “These clinical trials and paper have put Nagpur on the global map,” he said.
The study has also addressed the common understanding that patients with insulin treated diabetic mellitus (ITDM) had a higher risk of cardiovascular diseases. Almost 35% of the general population suffers from diabetes and hence a study was needed to know which stent works better in ITDM and non-ITDM patients. Otherwise too, diabetes and revascularization or opening the blood vessels using a particular method has always been debated. Doctors debated on the choice of procedures as well as between surgery and simple interventional procedures like angioplasty.
“The choice of procedure actually depends on the severity of the cardiac disease, number of blockages, type of blockages, and presence or absence of diabetes, patients’ preference, financial status of the patient and, above all, the type of stent. This study has shown that the everolimus stents yield better results in patients with diabetes and patients who are on insulin,” said Dr Jagtap.
Diabetes causes different types of blocks in the blood vessels, which can be small or big, concentrated at one point or spread parallel along the vessel. This study formally called as the ‘TUXEDO’ (Taxus Element Vs Xience Prime in a Diabetic Population) trial has shown that the everolimus stents have better efficacy and safety compared to the paclitaxel eluting stents.
Dr Jagtap is known for bringing in various firsts in the treatment of cardiac diseases in city. He was the first one to introduce trans-radial or hand based angiography, absorbable stents and the fractional flow reserve (FFR), a technique used in coronary catheterization, to measure pressure differences across a coronary artery.