[Percutaneous coronary intervention in patients with diabetes mellitus]

Abstract

The incidence of restenosis after percutaneous coronary intervention (PCI) in patients with ischemic heart disease and diabetes is increased compared to non-diabetics. The use of stents has reduced the incidence of restenosis significantly but the effect is not convincing, as restenosis in diabetics predominantly consists of intimal hyperplasia. Even with the use of stents, diabetics have increased morbidity and mortality compared to non-diabetics. The precise mechanism is unknown but may include the metabolic abnormalities characteristic of diabetes. No randomised prospective studies in diabetics compare coronary artery by-pass grafting (CABG) with optimal angioplastic therapy. We await such studies to clarify the conditions for diabetics. Retrospective subgroup analyses indicate a more favourable outcome in diabetics revascularised by CABG. Thus CABG is presumably the optimal revascularisation treatment for diabetics with three-vessel disease.