Key result
Diabetes is associated with higher mortality and morbidity following PCI compared with non-diabetics.
Why the study?
Diabetics have increased cardiovascular risk and derive less benefit from standard CAD therapies, with unique pathophysiological responses affecting PCI outcomes, necessitating updated understanding of revascularisation strategies.
Diabetics face higher PCI risks due to unique pathophysiology; leaves open whether evolving techniques will narrow outcome gaps with nondiabetics.
Diabetics are at an increased risk of cardiovascular morbidity and mortality as a consequence of inherent metabolic abnormalities and comorbidities. Furthermore, these patients derive less benefit from the standard therapies of coronary artery disease (CAD); the unique pathophysiological response to arterial injury has a profound effect on outcomes of percutaneous coronary interventions (PCIs). However, as the technology, techniques and experience of operators in PCI are evolving, the understanding of revascularisation strategies and patterns of clinical practice are changing. In this review, we discuss specific issues related to cardiac intervention in diabetics. Currently, diabetes affects >180 million people worldwide. In the current era of advanced medical therapy, improved medical facilities and medical infrastructure, the term myocardial infarction (MI) equivalent might not hold true.1 However, despite improved outcomes, the gradient of increased risk of mortality and morbidity as compared with non-diabetics persists throughout the spectrum of CAD. Diabetics constitutes around one quarter of patients undergoing revascularisation. Both types of revascularisation strategies have been evaluated extensively. Preoperative mortality, repeat revascularisation and long-term mortality are the issues of concern. Diabetes is a metabolic disorder characterised by chronic hyperglycaemia and insulin resistance. Disturbed delicate balance of fibrinolytic system as well as abnormalities of platelet structure and function results (box 1) in a persistent prothrombotic milieu.2 (A) Metabolic factors : Hyperglycaemia include endothelial dysfunction, vascular effects of advanced glycation end products, adverse effects of circulating free fatty acids and increased systemic inflammation. (B) Vascular anatomic characters : Diabetics have more frequent diffuse disease, higher prevalence of extensive CAD, left main disease, multivessel disease and occlusions. The narrow calibred vessels are associated with impaired collateral development. (C) Adverse prothrombotic milieu and high atherosclerotic burden : Proteofibrinolytic system and platelet biology are unfavourably altered in diabetes and a state of platelet activation exists. Glycoprotein IIb/IIIa (GP …
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Amit Malviya (2015) conducted a review in Coronary artery disease in diabetes. Percutaneous coronary intervention vs. Non-diabetics was evaluated. Percutaneous coronary interventions in diabetic patients are associated with an increased risk of mortality and morbidity compared with non-diabetics due to persistent metabolic and vascular factors.
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