Several clinical trials have demonstrated that outcomes after myocardial revas-cularization are different in diabetic patients compared to nondiabetic patients. These differences should influence treatment decisions.
Over the last decade, percutaneous coronary intervention (PCI) has gained increasing acceptance as an alternative to CABG surgery in selected patients. However, several reports demonstrating reduced long-term survival in diabetic patients treated with standard coronary balloon angioplasty have led to concerns regarding the use of PCI in this group of patients. A complete understanding of the mechanisms responsible for the reduced survival is of critical importance in the management of diabetic patients.
The operative and procedural management of diabetics with symptomatic CAD will be discussed based on the type of intervention employed. This section will detail the short- and long-term clinical outcomes associated with standard balloon PCI, PCI with stents, and CABG surgery in diabetic subjects. Where it is germane, there will be a discussion of the role of adjunctive therapies—notably the GP IIb/IIIa inhibitors—in the management of the diabetic patient who is undergoing catheter-based revascularization.
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