Revascularization strategies in patients with Type 2 diabetes mellitus

Abstract

This review aims to describe new developments in coronary revascularization strategies for patients with pre-existing Type 2 diabetes mellitus (DM). Recommended strategies for revascularization have been an active area of study with recent important developments. In patients with Type 2 DM and multivessel coronary artery disease (CAD), coronary artery bypass graft (CABG) surgery is the preferred method for revascularization. Patients with DM are at increased risk for diffuse cardiovascular disease due to the proinflammatory, prothrombotic effects of chronic hyperglycemia. In patients undergoing percutaneous coronary intervention, drug-eluting stents and more potent antiplatelet agents especially in those presenting with acute coronary syndromes should be employed.

Keywords::

• acute coronary syndrome
• coronary artery bypass graft surgery
• coronary revascularization
• diabetes mellitus
• percutaneous coronary intervention
• stable coronary disease

Financial & competing interests disclosure

R Mehran has received Institutional Research Grant Support from The Medicines Company, Bristol-Myers Squibb/Sanofi and Lilly/Daichii Sankyo and has acted as consultant for Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, Janssen, Regado Biosciences, Maya Medical and Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Diabetics are at increased risk for diffuse cardiovascular disease due to the proinflammatory, prothrombotic effects of chronic hyperglycemia.

• • Use of stents in diabetics is associated with an increased need for repeat revascularization.

• • There is no convincing difference between different drug-eluting stents when used in diabetics.

• • Coronary artery bypass graft surgery is the preferred option for diabetic patients with multivessel coronary artery disease.

• • Longer-term results are required for this chronic disease.

• • Internal mammary artery graft use is associated with improved outcomes in diabetics.

• • Diabetic patients have worse outcomes when presenting with acute coronary syndrome and thus an early invasive strategy is preferred.

• • Diabetics require more potent anti-platelet agents when presenting with acute coronary syndrome.