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Controversies surrounding percutaneous coronary intervention in the diabetic patient

Sara C Martinez1, David R Holmes1

  • 1a Division of Cardiovascular Disease , Mayo Clinic , Rochester , MN , USA.

Expert Review of Cardiovascular Therapy
|February 4, 2016
PubMed

Insights

Diabetic patients with coronary artery disease face aggressive atherosclerosis and complications. Complete revascularization and guideline-directed medical therapy offer the best outcomes, narrowing the gap with non-diabetic patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Vascular Biology

Background:

  • Diabetic patients with coronary artery disease (CAD) exhibit accelerated atherosclerosis.
  • They experience higher rates of stent complications and incomplete revascularization in multivessel disease.
  • Insulin resistance significantly impacts CAD presentation and progression.

Purpose of the Study:

  • To review the pathophysiology of insulin resistance in diabetic CAD.
  • To examine revascularization strategies and their impact on diabetic patient outcomes.
  • To identify optimal treatment approaches for diabetic patients with CAD.

Main Methods:

  • Literature review focusing on pathophysiology and clinical outcomes.
  • Analysis of data on revascularization strategies in diabetic populations.
  • Synthesis of evidence regarding guideline-directed medical therapy.

Main Results:

  • Diabetic CAD is characterized by aggressive atherosclerosis and higher complication rates.
  • Revascularization strategies have evolved, with complete and durable approaches showing promise.
  • Guideline-directed medical therapy is crucial for managing diabetic CAD.

Conclusions:

  • Complete and durable revascularization is essential for improving outcomes in diabetic patients with CAD.
  • Guideline-directed medical therapy is a cornerstone of treatment.
  • Optimizing these strategies can help close the outcome gap between diabetic and non-diabetic patients.

Keywords:
BARI2DCabgDESPCIbare metal stentcomplete revascularizationdiabetesdrug-eluting stenthybrid revascularizationsyntax

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