Diabetes and acute coronary syndromes.
Diabetic patients with acute coronary syndromes (ACSs) are at a high risk for subsequent cardiovascular events but derive, at the same time, greater benefit from evidence-based therapy than non-diabetic individuals. State-of-the-art anti-thrombotic therapy includes a triple anti-platelet combination - aspirin, clopidogrel and glycoprotein (GP) IIb/IIIa receptor inhibitors - and unfractionated heparin or enoxaparin. For low- or medium-risk individuals, a treatment based on aspirin, clopidogrel and bivalirudin is a valuable alternative. Prasugrel, a new and more potent inhibitor of the platelet P2Y(12) receptor, has to be regarded as the most promising anti-thrombotic agent for diabetic patients with ACS. This agent may replace clopidogrel - and possibly GP IIb/IIIa inhibitors - in the future. In addition to aggressive anti-thrombotic therapy, diabetic patients should undergo systematic early invasive angiography if presenting with non-ST-segment elevation ACS, and immediate percutaneous coronary intervention if presenting with ST-segment elevation myocardial infarction. Indeed, the benefit derived from these strategies appears to be more pronounced in the diabetic population than in non-diabetic individuals. Despite the benefit, multiple surveys have demonstrated that, in the setting of ACS, diabetic patients receive evidence-based therapy less frequently than non-diabetic counterparts.
Roffi
Marco
M
Division of Cardiology, University Hospital, Geneva, Switzerland. marco.roffi@hcuge.ch
Eberli
Franz R
FR
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D000077144:Clopidogrel; D003920:Diabetes Mellitus / Q000188:drug therapy*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D017984:Enoxaparin / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D010446:Peptide Fragments / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D000068799:Prasugrel Hydrochloride; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D013927:Thrombosis / Q000188:drug therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000925:Anticoagulants; D001786:Blood Glucose; D017984:Enoxaparin; D006629:Hirudins; D007004:Hypoglycemic Agents; D010446:Peptide Fragments; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin; C074619:bivalirudin