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Optimal Choice of Coronary Revascularization and Stent Type in Diabetic Patients with Coronary Artery Disease
Patients with diabetes mellitus (DM) are prone to a diffuse and accelerated form of coronary artery disease (CAD), which in turn is a major cause of cardiac-related morbidity and mortality. Compared with patients without diabetes, patients with diabetes undergoing coronary revascularization are at h...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Healthcare
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107438/ https://www.ncbi.nlm.nih.gov/pubmed/25135290 http://dx.doi.org/10.1007/s40119-013-0014-3 |
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author | Harskamp, Ralf E. Park, Duk-Woo |
author_facet | Harskamp, Ralf E. Park, Duk-Woo |
author_sort | Harskamp, Ralf E. |
collection | PubMed |
description | Patients with diabetes mellitus (DM) are prone to a diffuse and accelerated form of coronary artery disease (CAD), which in turn is a major cause of cardiac-related morbidity and mortality. Compared with patients without diabetes, patients with diabetes undergoing coronary revascularization are at higher risk of procedural, short-, and long-term cardiovascular events and mortality. Although coronary artery bypass grafting (CABG) has been regarded as the primary revascularization strategy in diabetic patients with complex CAD, percutaneous coronary intervention (PCI) is an effective revascularization alternative, due to remarkable advances in stent devices and adjunctive drug therapies. Outcomes data, from subgroup analyses and small-sized clinical trials and large registries, have suggested that PCI with current stent technology showed comparable long-term risks of mortality and hard endpoints, but higher risk of repeat revascularization for the diabetic population compared to CABG. However, the recent landmark International Future REvascularization Evaluation in patients with diabetes mellitus: optimal management of Multivessel disease (FREEDOM) trial provides compelling evidence of the superiority of CABG over PCI in reducing the rates of death, myocardial infarction, at the expense of stroke, in patients with diabetes with advanced CAD. When opting for PCI in patients with diabetes, currently used drug-eluting stents (DES) are more efficient in reducing the risk of repeat revascularization without compromising safety outcomes, compared to bare-metal stents. The selection of a specific type of DES in patients with diabetes is controversial and therefore more data comparing second- and newer-generation DES for patients with diabetes are currently needed. Also, efforts to make more advanced DES platforms suitable for patients with diabetes with complicated angiographic features are still ongoing. |
format | Online Article Text |
id | pubmed-4107438 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Springer Healthcare |
record_format | MEDLINE/PubMed |
spelling | pubmed-41074382014-07-24 Optimal Choice of Coronary Revascularization and Stent Type in Diabetic Patients with Coronary Artery Disease Harskamp, Ralf E. Park, Duk-Woo Cardiol Ther Review Patients with diabetes mellitus (DM) are prone to a diffuse and accelerated form of coronary artery disease (CAD), which in turn is a major cause of cardiac-related morbidity and mortality. Compared with patients without diabetes, patients with diabetes undergoing coronary revascularization are at higher risk of procedural, short-, and long-term cardiovascular events and mortality. Although coronary artery bypass grafting (CABG) has been regarded as the primary revascularization strategy in diabetic patients with complex CAD, percutaneous coronary intervention (PCI) is an effective revascularization alternative, due to remarkable advances in stent devices and adjunctive drug therapies. Outcomes data, from subgroup analyses and small-sized clinical trials and large registries, have suggested that PCI with current stent technology showed comparable long-term risks of mortality and hard endpoints, but higher risk of repeat revascularization for the diabetic population compared to CABG. However, the recent landmark International Future REvascularization Evaluation in patients with diabetes mellitus: optimal management of Multivessel disease (FREEDOM) trial provides compelling evidence of the superiority of CABG over PCI in reducing the rates of death, myocardial infarction, at the expense of stroke, in patients with diabetes with advanced CAD. When opting for PCI in patients with diabetes, currently used drug-eluting stents (DES) are more efficient in reducing the risk of repeat revascularization without compromising safety outcomes, compared to bare-metal stents. The selection of a specific type of DES in patients with diabetes is controversial and therefore more data comparing second- and newer-generation DES for patients with diabetes are currently needed. Also, efforts to make more advanced DES platforms suitable for patients with diabetes with complicated angiographic features are still ongoing. Springer Healthcare 2013-03-26 2013-06 /pmc/articles/PMC4107438/ /pubmed/25135290 http://dx.doi.org/10.1007/s40119-013-0014-3 Text en © Author(s) 2013 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. |
spellingShingle | Review Harskamp, Ralf E. Park, Duk-Woo Optimal Choice of Coronary Revascularization and Stent Type in Diabetic Patients with Coronary Artery Disease |
title | Optimal Choice of Coronary Revascularization and Stent Type in Diabetic Patients with Coronary Artery Disease |
title_full | Optimal Choice of Coronary Revascularization and Stent Type in Diabetic Patients with Coronary Artery Disease |
title_fullStr | Optimal Choice of Coronary Revascularization and Stent Type in Diabetic Patients with Coronary Artery Disease |
title_full_unstemmed | Optimal Choice of Coronary Revascularization and Stent Type in Diabetic Patients with Coronary Artery Disease |
title_short | Optimal Choice of Coronary Revascularization and Stent Type in Diabetic Patients with Coronary Artery Disease |
title_sort | optimal choice of coronary revascularization and stent type in diabetic patients with coronary artery disease |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107438/ https://www.ncbi.nlm.nih.gov/pubmed/25135290 http://dx.doi.org/10.1007/s40119-013-0014-3 |
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