Summary And Future Directions

It is clear that coronary atherosclerosis is prevalent, underrecognized, and a major cause of morbidity and mortality in the adult diabetic population. Preventive measures coupled with aggressive screening methods are indicated to both retard the development of CAD and to identify those patients who may benefit from life-prolonging and enhancing revascularization strategies. Although it is well established that revascularization is beneficial in the diabetic patient, it is also evident that the results obtained by revascularized diabetic patients are inferior to those achieved by nondiabetic patients. Recently reported studies have focused attention on certain aspects of revascularization that enhance outcomes (use of arterial grafts, stents, IIb/IIIa platelet receptor inhibitors), and provided some guidance regarding selection of PCI versus CABG. However, even with optimal recognition of revascularization candidates and use of optimal revascularization techniques, current studies suggest that progression of disease in diabetic patients plays a large role in limiting the long-term benefit of these procedures. Further treatment of the diabetic patient must address this issue of coronary disease progression, a topic explored in preceding chapters.

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