[Percutaneous coronary intervention in diabetic patients].
Diabetic patients represent one-quarter of all patients undergoing percutaneous coronary intervention (PCI). However, ten years ago a clinical alert recommended coronary artery bypass graft surgery for diabetic patients with multivessel disease. Diabetes is a risk factor for death, myocardial infarction and restenosis. The indications of PCI were re-evaluated after the advent of stenting and anti-GPIIbIIa drugs. In high-risk surgical populations such as those with acute coronary syndromes or prior Coronary Artery by pass Graft surgery-(CABG), PCI is a valuable alternative, even with bare metal stents. Stents eluting sirolimus or paclitaxel reduced the restenosis rate by about 80%, without modifying the risk of death or myocardial infarction. The first results of the EVASTENT study, a real-life study involving French patients treated with sirolimus-eluting stents, confirmed the increased rate of stent thrombosis in diabetic patients (2.5% vs 0.9%, p < 0.001). Drug eluting stent (DES) and abciximab give excellent results after PCI in diabetic patients with single-vessel disease. PCI is also promising for patients with multivessel disease but requires further evaluation in randomized trials. Secondary prevention is of paramount importance.
Lablanche
Jean-Marc
JM
Service de Cardiologie B et Hémodynamíquè, Hôpital Cardiologique, CHU de Lille--Boulevard du Pr. Jules Leclercq, 59037 Lille.
Rosey
Guillaume
G
Zoubidi
Mohamed
M
Sudre
Arnaud
A
D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000503:physiopathology* / Q000628:therapy*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D016503:Drug Delivery Systems; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D015607:Stents
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex