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The role of PCI and CABG in the management of coronary artery disease in patients with diabetes

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Abstract

The role of percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) in patients with diabetes mellitus (DM) is evolving. Data from clinical trials and observational studies are reviewed as well as current clinical practice guidelines. The importance of aggressive medical therapy to achieve recommended glycemic control targets, and management of usual risk factors in patients with coronary artery disease (CAD) cannot be overemphasized regardless of the revascularization therapy selected. Patients with type 2 diabetes are at increased risk for CAD, which is the cause of death in the majority of patients. Outcomes following PCI and CABG are worse in patients with DM compared to those without DM. This calls for randomized trials and other studies focused on patients with DM.

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References and Recommended Reading

  1. Ford ES, DeStephano F: Risk factors for mortality from all causes and from coronary heart disease among persons with diabetes: finding from the National Health and Nutrition Examination Survey I epidemiologic follow-up study. Am J Epidemiol 1991, 133:1220–1230.

    PubMed  CAS  Google Scholar 

  2. Gu K, Cowie CC, Harris MI: Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care 1998, 21: 1138–1145.

    Article  PubMed  CAS  Google Scholar 

  3. Mokdad AH, Ford ES, Bowman, et al.: Diabetes trends in the United States 1990-1998. Diabetes Care 2000, 23:1278.

    Article  PubMed  CAS  Google Scholar 

  4. Mokdad AH, Serdula M, Dietz B, et al.: The spread of the obesity epidemic in the U.S. JAMA 1999, 282:1519–1522.

    Article  PubMed  CAS  Google Scholar 

  5. The effect of intensive complication in insulin dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group [no authors listed]. N Engl J Med 1993, 329:977–986.

  6. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patient with type 2 diabetes (UKPDS33). UK Prospective Diabetes Study (UKPDS) Group [no authors listed]. Lancet 1998, 352:837–853. A true landmark RCT of glycemic control.

  7. Consensus Development Conference on the Diagnosis of coronary heart disease in people with diabetes: 10-11 Feb 1998, Miami, Florida. American Diabetes Association [no authors listed]. Diabetes Care 1998, 21: 1551–1559.

  8. The BARI Investigators: Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996, 335:217–225.

    Google Scholar 

  9. Kurbaan AS, Bowker TJ, Ilsley CD, et al.: Difference in the mortality of the CABRI diabetic and nondiabetic populations and its relation to coronary artery disease and the revascularization mode. Am J Cardiol 2001, 87:947–950.

    Article  PubMed  CAS  Google Scholar 

  10. King SB, Kosinski AS, Guyton, et al.: Eight year mortality in the Emory Angioplasty versus Surgery Trial (EAST). J Am Coll Cardiol 2000, 35:1116–1121.

    Article  PubMed  Google Scholar 

  11. Detre KM, Guo P, Holubkov R, et al.: Coronary revasculariza-tion in diabetic patients; a comparison of the randomized and observational components of the Bypass Angioplasty Revascularization Investigation (BARI). Circulation 1999, 99:633–640. References 8, 9, and 10 represent the major randomized trials comparing CABG and PTCA in multivessel CAD.

    PubMed  CAS  Google Scholar 

  12. Barsness GW, Peterson ED, Ohman EM, et al.: Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty. Circulation 1997, 96:2551–2556.

    PubMed  CAS  Google Scholar 

  13. Niles NW, McGrath PD, Malenka D, et al.: Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: Results of a large regional prospective study. J Am Coll Cardiol 2001, 37:1008–1015. A recent and very important observational study confirming original BARI trial results.

    Article  PubMed  CAS  Google Scholar 

  14. Gum PA, O’Keefe JH, Borkon AM, et al.: Bypass surgery versus coronary angioplasty for revascularization of treated diabetic patients. Circulation 1997, 96(suppl II):II7-II10.

    Google Scholar 

  15. Hansson L, Zanchetti A, Carruthers SG, et al., for HOT Study Group: Effects of intensive blood pressure lowering and low dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998, 351:7155–7162.

    Article  Google Scholar 

  16. Pyorala K, Pedersen TR, Kjekshus U, The Scandinavian Simvas-tatin Survival Study (4S) Groups, et al.: Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease: a subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care 1997, 20:614–620.

    Article  PubMed  CAS  Google Scholar 

  17. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE Study and MICROHOPE Substudy. The Heart Outcomes Prevention and Evaluation Investigators [no authors listed]. Lancet 2000, 355:253–259.

  18. Brenner BM, Cooper ME, deZeeur D, et al.: The losartan renal protection study-rational study design and baseline characteristics of RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan). FRAAS 2000, 1:328–335.

    CAS  Google Scholar 

  19. American Diabetes Association: Aspirin therapy in diabetes (position statement). Diabetes Care 1997, 20:1772–1773.

    Google Scholar 

  20. Marso SP, Lincoff AM, Ellis SG, et al.: Optimizing the percutaneous interventional outcomes for patient with diabetes mellitus: results of the EPISTENT (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial) diabetic substudy. Circulation 1999, 100: 2477–2484.

    PubMed  CAS  Google Scholar 

  21. Corpus RA, George PB, Ajluni SC, et al.: Optimal glycemic control is associated with lower rates of target vessel revascularization diabetics undergoing elective percutaneous coronary intervention. J Am Coll Cardiol 2001, 37(suppl A):66A.

    Google Scholar 

  22. Lazar HL, Chipkin S, Philippdes G: Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations. Ann Thorac Surg 2000, 70:145–150.

    Article  PubMed  CAS  Google Scholar 

  23. Malmberg K: Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 1997, 314: 1512–1515.

    PubMed  CAS  Google Scholar 

  24. Seven-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status [no authors listed]. J Am Coll Cardiol 2000, 35:1122–1129.

  25. Detre KM, Lombardero MS, Brooks MM, et al.: The effect of previous coronary artery bypass surgery on the prognosis of patient with diabetes who have acute myocardial infarction. Bypass Angioplasty Revascularization Investigators. N Engl J Med 2000, 342:989–997.

    Article  PubMed  CAS  Google Scholar 

  26. Feit F, Brooks MM, Sopko G, et al.: Long-term clinical outcomes in the Bypass Angioplasty Revascularization Investigation Registry: comparison with the randomized trial. Circulation 2000, 101: 2795–2802.

    PubMed  CAS  Google Scholar 

  27. Newman MF, Kirchner BS, Phillips-Bute B, et al.: Longitudinal assessment of neurocognitive function after coronary artery bypass surgery. N Engl J Med 2001, 344:395–402.

    Article  PubMed  CAS  Google Scholar 

  28. Serruys PW, Unger F, Sousa JE, et al.: Comparison of coronary artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 2001, 344:1117–1124.

    Article  PubMed  CAS  Google Scholar 

  29. O’Neill WW: Multivessel angioplasty should be abandoned in diabetic patients [comment]. J Am Coll Cardiol 1998, 31: 20–22.

    PubMed  CAS  Google Scholar 

  30. Brener SJ, Ellis SG, Sapp SK, et al.: Predictors of death and reinfarction at 30 days after primary angioplasty: the GUSTO IIb and RAPPORT trials. Am Heart J 2000, 139:476–481.

    PubMed  CAS  Google Scholar 

  31. Mak KH, Moliterno DJ, Granger CB, et al.: Influence of diabetes mellitus on clinical outcomes in the thrombolytic era of acute myocardial infarction. J Am Coll Cardiol 1997, 30:171–179.

    Article  PubMed  CAS  Google Scholar 

  32. Williams DO, Holubkov R, Yeh W, et al.: Percutaneous coronary intervention in the current era compared with 1985-1986; the National Hear, Lung, and Blood Institute Registries. Circulation 2000, 102: 2945–2951.

    PubMed  CAS  Google Scholar 

  33. Jacobs AK, Brooks MM, Faxon DP, et al.: Has outcome improved in diabetic patients undergoing coronary revascularization? Report from the NHLBI Dynamic Registry and Bypass Angioplasty Revascularization Investigation. Circulation 1999, (suppl):1060I–1067I.

  34. Kuntz RE: Importance of considering atherosclerosis progression when choosing a coronary revascularization strategy: the diabetes percutaneous transluminal coronary angioplasty dilemma. Circulation 1999, 99:847–851.

    PubMed  CAS  Google Scholar 

  35. Kornowski R, Mintz GS, Kent KM, et al.: Increased restenosis in diabetes mellitus after coronary intervention is due to exaggerated intimal hyperplasia: a serial intravascular ultrasound study. Circulation 1997, 95:1366–1369.

    PubMed  CAS  Google Scholar 

  36. Van Belle E, Bauters C, Hubert E, et al.: Restenosis rates in diabetic patients: a comparison of coronary stenting and balloon angioplasty in native coronary vessels. Circulation 1997, 96:1454–1460.

    PubMed  Google Scholar 

  37. Standl E, Schnell O: A new look at the heart in diabetes mellitus: from ailing to failing. Diabetologia 2000, 43:1455–1469.

    Article  PubMed  CAS  Google Scholar 

  38. Marso SP, Ellis SG, Gurm HS, et al.: Proteinuria is a key determinant of death in patients with diabetes after isolated coronary artery bypass grafting. Am Heart J 2000, 139:939–944.

    Article  PubMed  CAS  Google Scholar 

  39. Jager A, vanHinsbergh VWM, Kostense PJ, et al.: VonWillebrand Factor, C-reactive protein and 5 year mortality in diabetic and non-diabetic subjects: the Hoorn Study. Arterioscler Thromb Vasc Biol 1999, 19:3071–3078.

    PubMed  CAS  Google Scholar 

  40. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2001, 37:2239.

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Authors and Affiliations

  1. Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Robert L. Frye MD

Authors
  1. Robert L. Frye MD
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  2. Malcolm R. Bell MD
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  3. Hartzell V. Schaff MD
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  4. Richard Holubkov PhD
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  5. Katherine M. Detre MD, DrPH
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Frye, R.L., Bell, M.R., Schaff, H.V. et al. The role of PCI and CABG in the management of coronary artery disease in patients with diabetes. Curr Diab Rep 2, 16–20 (2002). https://doi.org/10.1007/s11892-002-0052-z

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