Diabetes and endothelial function: implications for coronary angioplasty.

Abstract

Complications from coronary artery disease remain the leading cause of mortality in subjects with diabetes mellitus. As such, coronary revascularization is frequently performed in patients with diabetes. Percutaneous coronary intervention has been widely applied to patients with coronary disease including those with diabetes.1Whereas success rates remain high it is clear that outcomes in patients with diabetes are worse than those without diabetes. Kip et al. reported on the 9 year follow-up from the 1985-86 NHLBI angioplasty registry.2Patients with diabetes tended to be older, were more likely to be female, have more extensive coronary disease and have greater comorbidity. Despite this, acute success and the degree of revascularization were the same, but in-hospital events were higher. The 9 year mortality was almost twice as high in those with diabetes (35.9 vs 17.9%). Similarly, there was an excess of non-fatal myocardial infarctions, coronary bypass surgery and repeat angioplasty. Diabetes remained a significant independent risk factor in multivariate analysis. Similar long-term registry data has been reported by others.3;4