Coronary revascularization in patients with diabetes

Abstract

Although coronary stents, glycoprotein IIb/IIIa receptor blockers, and insulin infusion appear to reduce morbidity in diabetic patients undergoing revascularization, long-term outcomes remain poorer for diabetic patients than for non-diabetic patients. Among patients with diabetes, insulin treatment is a consistent marker of worse outcomes. Randomized controlled trial results show that diabetic patients with multivessel disease have improved long-term survival with initial coronary artery bypass surgery (CABG) treatment compared with percutaneous transluminal coronary angioplasty, an effect not seen in non-diabetic patients. The advantage with CABG is apparent earlier in insulin-treated patients. This benefit with CABG may be related to a protective effect following myocardial infarction, as prior CABG greatly reduced the risk of death following spontaneous Q-wave myocardial infarction in diabetic patients (relative risk 0.09) but not in non-diabetic patients. Overall, however, the high incidence of cardiac events and poorer long-term outcomes in diabetic patients after revascularization underscore the palliative nature of these procedures in this population and the need to treat risk factors aggressively.