TOPLINE:

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.

DISCLOSURES:

Two authors disclosed receiving support from the Swedish Heart Lung Foundation, Region Stockholm, and/or Konung Gustaf V:s och Drottning Victorias Stiftelse. Some authors disclosed receiving personal lecture fees, lecture and consulting fees, or honoraria and having other ties with various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.