[Treatment of coronary insufficiency in diabetics: Part 2: acute coronary insufficiency].
Treatment of acute coronary insufficiency in diabetics--recent myocardial infarction (MI--unstable angina--uses the same modalities as in the absence of diabetes. Thrombolytics improve the prognosis of MI, although the hospital mortality remains about two fold in the presence of diabetes. Primary angioplasty has an identical success rate, but restenoses are significantly more frequent in diabetics. Systematic use of stents allows a reduction of the restenosis rate to the level observed in the absence of diabetes. In unstable angina, low molecular weight heparins have an efficacy and a safety identical to those observed in non-diabetic patients. There is therefore no limitation to their use. Diabetics present permanent activation of blood platelets which promotes their adhesion and aggregation. Aspirin must therefore be systematically prescribed to diabetic patients, except in the presence of a contraindication, especially gastrointestinal, in which case, ticlopidine can be used. Platelet glycoprotein IIB-IIIA receptor inhibitors have the same indications and provide the same results as in the absence of diabetes. Contrary to a widely held belief, beta-blockers, especially cardioselective, can be widely used in diabetics. The same applies to angiotensin converting enzyme inhibitors. Finally, during the acute phase of coronary insufficiency, continuous insulin infusion via a pump ensures better control of diabetes and also decreases the mortality of MI. Permanent collaboration between cardiologists and diabetologists is therefore essential to increase the efficacy of treatment and to improve the prognosis of acute coronary insufficiency in diabetic patients.
Grand
A
A
Service de Cardiologie, Centre Hospitalier de Valence, 26953 Valence.
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000789:Angina, Unstable / Q000209:etiology* / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003327:Coronary Disease / Q000209:etiology* / Q000628:therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007328:Insulin / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D015607:Stents; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D007004:Hypoglycemic Agents; D007328:Insulin; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin