Among the risk factors for ischemic cardiopathy none influences more long-term restenosis and mortality as diabetes mellitus. Diabetes mellitus is ranked third as cause of death; 65 to 85% of these patients die due to cardiovascular disease. The use of coronary stents associated to glycoprotein IIb/IIIa inhibitors has proven to be superior to stents alone or PTCA in the treatment of ischemic cardiopathy in diabetic patients. Despite these improved results, restenosis rates remain higher as compared to non-diabetic patients. Intracoronary radiation has been shown decrease restenosis and repeat target lesion revascularizations in diabetic patients with intra-stent restenosis. In order to decrease restenosis in diabetic patients, stents coated with site-specific pharmacological and molecular approaches may prove useful in suppressing hyperplasia of the intimal and preventing restenosis. Coronary artery bypass grafting seems to be the best option for diabetic patients with multiple coronary artery disease, especially if they have proximal left anterior descending artery estenosis, complex lesions to be approached by angioplasty, previous myocardial infarction, three vessel disease, or impaired left ventricular function. In spite of improvements in the treatment of diabetic patients with coronary artery disease, restenosis and mortality rates continue to be higher as compared to non-diabetic patients; therefore, new strategies are required.
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