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[Coronary angioplasty in diabetic patients]
Giuseppe Steffenino1, Eugenio La Scala, Lucilla Riva
1Laboratorio di Emodinamica Divisione di Cardiologia Azienda Ospedaliera SS. Croce e Carle Via M. Coppino, 26 12100 Cuneo. steffenino.g@scroce.sanitacn.it
Insights
Diabetics undergoing coronary angioplasty face poor outcomes due to increased restenosis and cardiac events. While stents improve results, new "zero restenosis" devices may offer future solutions for diabetic cardiovascular disease.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Interventional Cardiology
Context:
- Diabetic patients exhibit metabolic alterations like thrombogenicity and endothelial dysfunction, increasing risks post-coronary angioplasty.
- Balloon angioplasty outcomes are poor in diabetics, marked by high restenosis and cardiac events.
- Stent placement improves outcomes but doesn't eliminate recurrence compared to the general population.
Purpose:
- To review the challenges and current management strategies for diabetic patients undergoing coronary angioplasty.
- To discuss the impact of metabolic alterations on restenosis and cardiac events in diabetics.
- To evaluate the role of adjunct therapies and future device potential in improving outcomes.
Summary:
- Diabetic metabolic alterations contribute to poor outcomes after coronary angioplasty, primarily due to increased restenosis and cardiac events.
- Stenting has improved results but has not fully resolved recurrence issues in diabetic patients.
- Abciximab may aid angioplasty, and bypass grafting remains an option for multivessel disease, pending new zero-restenosis technologies.
Impact:
- Highlights the need for improved therapeutic strategies for diabetic cardiovascular disease.
- Underscores the potential of novel devices to significantly reduce restenosis rates.
- Informs clinical decision-making regarding angioplasty, stenting, and bypass grafting in diabetic patients.
Abstract:
Increased thrombogenicity, endothelial dysfunction, proliferation of both the cells and the matrix in the vessel walls, dislipidemia and insulin-resistance are the main metabolic alterations in the diabetic scenario, with possible implications in terms of vessel restenosis after coronary angioplasty. The outcome of balloon coronary angioplasty in diabetics is poor. This is due to both increased restenosis and a high incidence of medium/long-term cardiac events; the use of stents in these patients has substantially improved the results, but the recurrence rate has not been abated to the level observed in the general population. Abciximab may be a helpful adjunct to coronary angioplasty in these patients, while coronary artery bypass grafting may still be preferable--as at present--in case of multivessel coronary artery disease. This viewpoint is likely to be substantially modified in the near future, if the promise of "zero restenosis" devices is kept.