Optimal treatment for coronary artery disease in patients with diabetes: percutaneous coronary intervention, coronary artery bypass graft, and medications
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Hiroshi Ito, MD, PhD
- چاپ و سال / کشور: 2010
Description
There are three strategies for patients with coronary artery disease (CAD): medical therapy, coronary artery bypass graft (CABG), and percutaneous coronary intervention (PCI). With the development of drug-eluting stents, PCI is now widely used as the fi rstline treatment around the world. The advantage of CABG over PCI, however, remains in patients with left main coronary artery disease, three-vessel disease, and diffuse CAD. PCI and CABG do not exist in isolation because relieving the symptoms of angina is not the goal of treatment of CAD. Secondary prevention with vigorous modifi cation of risk factors should be initiated and maintained. Among coronary risk factors, diabetes mellitus (DM) remains the most important one to predict poor early and late outcomes even in patients undergoing complete revascularization with CABG. Lowering the blood glucose level is important, but strict glycemic control is not necessarily associated with further reduction of cardiovascular events. Modifi cation of insulin resistance with pioglitazone and metformin, lipid-lowering therapy with a statin, lowering blood pressure to <130/80 mmHg, and antiplatelet therapy should be considered in individuals with DM. A major concern is suboptimal modifi cations of risk factors in patients with DM and CABG in the real world. We should bear in mind this treatment gap and provide medical therapy for patients who need it most.
Gen Thorac Cardiovasc Surg (2011) 59:6–13 DOI 10.1007/s11748-010-0648-1 Received: 6 May 2010 / Accepted: 21 May 2010
