Percutaneous Coronary Intervention in Diabetics
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Diabetes mellitus (DM) is a major independent risk factor for coronary artery disease (CAD). The overall prevalence of CAD is as high as 55% among adult patients with DM. Atherosclerosis accounts for about 80% of all deaths from diabetes and DM is a recognized risk factor for poor outcome after coronary revascularisation.
While percutaneous revascularisation is an effective treatment strategy in patients with DM, it is however associated with higher rate of in-hospital complications, repeat revascularisation procedures, in-stent restenosis and lower event-free survival when compared to non-diabetics. The reasons for this include more diffuse and severe coronary artery disease, small-calibre vessels, rapid progression of new disease, and altered platelet and endothelial function. In patients with multivessel disease, diabetic patients had lower 5-year survival undergoing angioplasty compared to coronary bypass surgery (66% vs 81%) in the Bypass angioplasty Revascularisation Investigation (BARI) trial. These may be attributed to increased frequency of restenosis and incomplete revascularisation achieved with angioplasty procedures. In general, DM patients with 2 or 3-vessel disease involving the proximal left anterior descending artery and abnormal left ventricular function should undergo CABG if suitable.
, 百拇医药
Advances in pharmacological therapy and technological innovation have been made in recent years to improve the outcomes of patients with DM undergoing catheter-based intervention. While the use of intracoronary stent in diabetics had reduced the rate of restenosis compared to balloon angioplasty, it is still beset with high rates of restenosis (30% to 40%) due to the excess neointimal hyperplasia. Restenosis may be silent and perhaps more hazardous. Brachytherapy is the only proven therapy in the treatment of in-stent restenosis. However, the emergence of drug-eluting stents may offer a new dimension to the treatment of this complication. The use of atherectomy (directional and rotational) and exciser laser angioplasty had not been shown to reduce the restenosis rate. The use of adjunct glycoprotein IIb/IIIa platelet receptor antagonist may be useful in diabetic patients undergoing PCI. The EPISTENT trial demonstrated a significant reduction of major ischemic cardiac events and target vessel resvascularisation in stented diabetic patients. Pooled data also showed that one-year mortality of diabetic patients was decreased with abciximab.
The optimal strategy of coronary revascularisation is an evolving one. Exciting advances in catheter-based therapies may have a positive influence on clinical outcomes in this high risk group of patients., 百拇医药
While percutaneous revascularisation is an effective treatment strategy in patients with DM, it is however associated with higher rate of in-hospital complications, repeat revascularisation procedures, in-stent restenosis and lower event-free survival when compared to non-diabetics. The reasons for this include more diffuse and severe coronary artery disease, small-calibre vessels, rapid progression of new disease, and altered platelet and endothelial function. In patients with multivessel disease, diabetic patients had lower 5-year survival undergoing angioplasty compared to coronary bypass surgery (66% vs 81%) in the Bypass angioplasty Revascularisation Investigation (BARI) trial. These may be attributed to increased frequency of restenosis and incomplete revascularisation achieved with angioplasty procedures. In general, DM patients with 2 or 3-vessel disease involving the proximal left anterior descending artery and abnormal left ventricular function should undergo CABG if suitable.
, 百拇医药
Advances in pharmacological therapy and technological innovation have been made in recent years to improve the outcomes of patients with DM undergoing catheter-based intervention. While the use of intracoronary stent in diabetics had reduced the rate of restenosis compared to balloon angioplasty, it is still beset with high rates of restenosis (30% to 40%) due to the excess neointimal hyperplasia. Restenosis may be silent and perhaps more hazardous. Brachytherapy is the only proven therapy in the treatment of in-stent restenosis. However, the emergence of drug-eluting stents may offer a new dimension to the treatment of this complication. The use of atherectomy (directional and rotational) and exciser laser angioplasty had not been shown to reduce the restenosis rate. The use of adjunct glycoprotein IIb/IIIa platelet receptor antagonist may be useful in diabetic patients undergoing PCI. The EPISTENT trial demonstrated a significant reduction of major ischemic cardiac events and target vessel resvascularisation in stented diabetic patients. Pooled data also showed that one-year mortality of diabetic patients was decreased with abciximab.
The optimal strategy of coronary revascularisation is an evolving one. Exciting advances in catheter-based therapies may have a positive influence on clinical outcomes in this high risk group of patients., 百拇医药