Copyright © 2004 by the European Society of Cardiology.
Review
Percutaneous coronary intervention in diabetic patients with non-ST-segment elevation acute coronary syndromes
a Division of Cardiology, University Hospital, Zurich, Switzerland
b Department of Cardiovascular Medicine, The Cleveland Clinic Foundation,Cleveland, Ohio, USA
Received September 11, 2003;
revised October 15, 2003;
accepted October 23, 2003
* Correspondence to: Eric J. Topol, MD, Department of Cardiovascular Medicine, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA. Tel: +1 216 445 9493; fax: +1 216 445 9595
E-mail address: topole{at}ccf.org
Key pathophysiologic mechanisms of diabetes-related coronary disease include inflammation and a prothrombotic state. In the setting of non-ST-segment elevation acute coronary syndromes diabetic patients are at high risk for subsequent cardiovascular events. At the same time, they derive greater benefit than non-diabetic counterparts from aggressive antithrombotic therapy, early coronary angiography, and stent-based percutaneous coronary intervention. The mainstays of antithrombotic therapy for diabetic patients undergoing percutaneous revascularization include aspirin, clopidogrel, platelet glycoprotein IIb/IIIa receptor antagonists, and heparin or low-molecular-weight heparin. Despite dramatic reduction in restenosis conferred by drug-eluting stents, diabetic patients remain at increased risk for repeat revascularization. More efforts are needed both in terms of local drug elution as well as systemic pharmacologic therapies to further contain the excessive neointimal proliferation that characterizes the diabetic response to vascular injury.
Key Words: Diabetes • Acute coronary syndromes • Percutaneous coronaryintervention • Stents • Glycoproteins • Antiplatelet therapy
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