[Therapeutic strategies to improve the outcome of patients with diabetes mellitus and acute coronary syndrome].
Diabetes mellitus is a major risk factor for cardiovascular morbidity and mortality. The burden of cardiovascular disease associated with this condition will increase dramatically, because the prevalence of diabetes is estimated to double over the next few decades. Diabetic patients show a poor short- and long-term outcome in the setting of ST-segment-elevation and non-ST-segment-elevation acute coronary syndromes, with a 2-fold acute mortality compared with non-diabetics. Although no specifically designed clinical trials in diabetics with acute coronary syndromes are available at present, many data suggest that an aggressive approach, such as early mechanical revascularization with the use of platelet glycoprotein IIb/IIIa inhibitors and of drug-eluting stents, associated with a strict glycemic control during hospital stay, can improve the prognosis of these patients. Nonetheless, these strategies appear to be underused in current practice, representing a missed opportunity for improving outcomes in this high-risk population.
Cavallini
Claudio
C
Struttura Complessa di Cardiologia, Ospedale R Silvestrini, Perugia. clcaval@tin.it
D000208:Acute Disease; D000789:Angina, Unstable / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015607:Stents; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D005343:Fibrinolytic Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D019039:Platelet Glycoprotein GPIIb-IIIa Complex