title: Current concepts on coronary revascularization in diabetic patients.
abstract: Diabetic mellitus (DM) patients with coronary artery disease (CAD) are at higher risk of cardiovascular events compared with non-DM individuals. While aggressive cardiovascular prevention and adequate blood glucose control remain cornerstones of therapy, the decision when and how to proceed to coronary revascularization in an individual DM patient should be based on the extent of CAD, ischaemic burden, ventricular function, as well as comorbidities. While in patients with stable symptoms, moderate CAD on coronary angiography and preserved left ventricular function a conservative strategy may be a valuable initial strategy, in patients with acute coronary syndromes (ACS) an early invasive approach should be favoured. The revascularization strategy for DM patients with complex multivessel CAD should be discussed within a heart team consisting of cardiologists, cardiac surgeons, and anaesthesiologists. In general, the threshold for coronary artery bypass surgery (CABG) should be lower for DM than for non-DM individuals. In patients undergoing percutaneous coronary intervention, the use of drug-eluting stents (DES) and--in the setting of ACS--of potent platelet inhibitors, such as prasugrel or ticagrelor, should be favoured. In the near future, multiple strategies may further favourably impact the prognosis of DM patients undergoing coronary revascularization. These include alternative antiplatelet agents such as thromboxane receptor inhibitors, the broad use of second generation DES, and possibly the implantation of bioresorbable stents. Coronary artery bypass surgery outcomes may also further improve by wide implementation of arterial revascularization, reduction in perioperative stroke by avoiding clamping of the aorta, reduction in wound infection by minimally invasive techniques, and optimization of post-operative medical management.
authors: Interventional Cardiology Unit, Division of Cardiology, University Hospital, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland. marco.roffi@hcuge.ch
authors: Marco
authors: M
authors: Roffi
authors: Dominick J
authors: DJ
authors: Angiolillo
authors: A Pieter
authors: AP
authors: Kappetein
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D058065:Diabetic Cardiomyopathies / Q000628:therapy*; D054855:Drug-Eluting Stents; D005544:Forecasting; D006801:Humans; D053208:Kaplan-Meier Estimate; D009204:Myocardial Revascularization / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex