doi: 10.1161/01.CIR.0000055653.52489.E9
(Circulation. 2003;107:1556.)
© 2003 American Heart Association, Inc.
Special Review |
Important Triad in Cardiovascular Medicine
Diabetes, Coronary Intervention, and Platelet Glycoprotein IIb/IIIa Receptor Blockade
From the Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to A. Michael Lincoff, MD, Associate Professor of Medicine, Department of Cardiovascular Medicine, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail LincofA@ccf.org
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
 |
Introduction |
|---|
Diabetes mellitus is a potent risk factor for greater prevalence, complexity, and complications of cardiovascular disease, and diabetics thus constitute a sizable proportion of patients for whom coronary revascularization is required. However, both percutaneous and surgical revascularization techniques are associated with particular challenges in this population. Diabetics typically have an increased likelihood of restenosis and repeat revascularization procedures after stenting compared with their non-diabetic counterparts.1 Trends toward higher death rates in diabetics have also been observed over 1 year or longer after stenting,1–4 and patients with diabetes thus remain one of the few groups for whom percutaneous coronary intervention (PCI) does not yet provide survival benefit commensurate with that of coronary artery bypass surgery.5–7 Diabetes mellitus is also a predictor of elevated mortality risk and accelerated disease progression after surgical revascularization.5,8,9
The processes leading to adverse prognosis after revascularization in diabetics are likely multifactorial and relate to widespread atheroma, small vessel vasculopathy, impaired collateral formation, exuberant neointimal hyperplasia, and adverse remodeling.10,11 There is also evidence that hypercoagulability contributes to accelerated atherosclerosis and exaggerated injury response after revascularization in diabetics.11–13 Diabetes is associated with increased levels of circulating fibrinogen, thrombin, and factor VII, and with diminished plasma fibrinolytic and antithrombin III activity. Moreover, platelets in diabetic patients are increased in size, are more frequently activated, and exhibit greater adhesiveness, thromboxane synthesis, glycoprotein (GP) IIb/IIIa expression, and mitogenic activity.
|
Glycoprotein IIb/IIIa Inhibitors and Diabetes |
|---|
Adjunctive antiplatelet therapy with GP IIb/IIIa blockade reduces the incidence of acute ischemic events by as much as 35% to 50% among the
This article has been cited by other articles:
 |
|
 |
|
  J. M. de la Hera, E. Delgado, E. Hernandez, J. M. Garcia-Ruiz, J. M. Vegas, P. Avanzas, I. Lozano, R. Barriales-Villa, S. Hevia, J. S. Martin, et al. Prevalence and outcome of newly detected diabetes in patients who undergo percutaneous coronary intervention Eur. Heart J., November 1, 2009; 30(21): 2614 - 2621. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Soran, A. Manchanda, and S. Schueler Percutaneous coronary intervention versus coronary artery bypass surgery in multivessel disease: a current perspective Interactive CardioVascular and Thoracic Surgery, June 1, 2009; 8(6): 666 - 671. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Daemen, K. H. Kuck, C. Macaya, V. LeGrand, M. Vrolix, D. Carrie, I. Sheiban, M. J. Suttorp, P. Vranckx, T. Rademaker, et al. Multivessel Coronary Revascularization in Patients With and Without Diabetes Mellitus: 3-Year Follow-Up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) Trial J. Am. Coll. Cardiol., December 9, 2008; 52(24): 1957 - 1967. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Daemen, E. Boersma, M. Flather, J. Booth, R. Stables, A. Rodriguez, G. Rodriguez-Granillo, W. A. Hueb, P. A. Lemos, and P. W. Serruys Long-Term Safety and Efficacy of Percutaneous Coronary Intervention With Stenting and Coronary Artery Bypass Surgery for Multivessel Coronary Artery Disease: A Meta-Analysis With 5-Year Patient-Level Data From the ARTS, ERACI-II, MASS-II, and SoS Trials Circulation, September 9, 2008; 118(11): 1146 - 1154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Daemen and P. W. Serruys Drug-Eluting Stent Update 2007: Part II: Unsettled Issues Circulation, August 21, 2007; 116(8): 961 - 968. [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Williams Coronary Revascularization in Diabetic Chronic Kidney Disease/End-Stage Renal Disease: A Nephrologist's Perspective Clin. J. Am. Soc. Nephrol., March 1, 2006; 1(2): 209 - 220. [Full Text] [PDF]
|
|
|
|
|
|
H. S. Gurm, I. J. Sarembock, D. J. Kereiakes, J. J. Young, R. A. Harrington, N. Kleiman, F. Feit, K. Wolski, J. A. Bittl, R. Wilcox, et al. Use of Bivalirudin During Percutaneous Coronary Intervention in Patients With Diabetes Mellitus: An Analysis From the Randomized Evaluation in Percutaneous Coronary Intervention Linking Angiomax to Reduced Clinical Events (REPLACE)-2 Trial J. Am. Coll. Cardiol., June 21, 2005; 45(12): 1932 - 1938. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.H. W. Tang and A. M. Lincoff Diabetes, Coronary Intervention, and Platelet Glycoprotein IIb/IIIa Blockade: The Triad Revisited Circulation, December 14, 2004; 110(24): 3618 - 3620. [Full Text] [PDF]
|
|
|
|
|
|
J. Mehilli, A. Kastrati, H. Schuhlen, A. Dibra, F. Dotzer, N. von Beckerath, H. Bollwein, J. Pache, J. Dirschinger, P. P. Berger, et al. Randomized Clinical Trial of Abciximab in Diabetic Patients Undergoing Elective Percutaneous Coronary Interventions After Treatment With a High Loading Dose of Clopidogrel Circulation, December 14, 2004; 110(24): 3627 - 3635. [Abstract] [Full Text] [PDF]
|
|