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Thorac Cardiovasc Surg 2004; 52(6): 349-355
DOI: 10.1055/s-2004-821322
Review

© Georg Thieme Verlag KG Stuttgart · New York

Diabetes Mellitus in Coronary Artery Surgery: Therapeutic Strategies in the Light of Recent Studies

A. H. Lauruschkat1 , J. Ennker1
  • 1Department of Cardiac, Thoracic and Vascular Surgery, Heart Institute Lahr/Baden, Lahr, Germany
Further Information

Publication History

Received August 5, 2004

Publication Date:
01 December 2004 (online)

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Abstract

Advances in percutaneous coronary revascularization have meant that, increasingly, patients with multivessel diseases are initially treated with the methods of interventional cardiology. Ongoing studies involving new stent coatings and optimized anti-thrombotic therapies could help to lower future restenosis rates and improve the success rate of stenting. Thrombocyte glycoprotein IIb/IIIa receptor blockers have already been shown to reduce the rate of acute PTCA complications in high-risk patients and could have a sustained impact on the long-term prognoses for PTCA patients. However, for diabetic patients with coronary multivessel diseases, coronary artery bypass grafting using arterial grafts as the initial revascularization method must be given preference over other therapy methods. Consequently, this group of patients is bound to grow in importance in cardiac surgery. The advances made in percutaneous coronary revascularization and in coronary surgery call for further prospective, controlled, randomized clinical studies in order to establish the best possible treatment strategy for patients with diabetes. It should be noted, however, that the therapeutic effect of myocardial revascularization is generally limited to individual coronary-arterial segments, whereas the pathological process of atherosclerosis is rather diffuse. The surgical strategy should therefore be seen as part of an overall strategy which encompasses other forms of treatment (e.g. intensive efforts to improve control of blood glucose level, blood pressure, and cholesterol level) in order to arrest the general progression of the disease and to reduce the risk of myocardial infarction and death.

Key words

Diabetes mellitus - coronary artery disease - coronary artery bypass grafting - mortality - myocardial infarction - risk factors

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MD Achim Helmut Lauruschkat

Cardiac, Thoracic and Vascular Surgery Heart Institute Lahr/Baden

Hohbergweg 2

77933 Lahr

Germany

Phone: + 497821925100

Fax: + 49 78 21 92 51 10

Email: Lauruschkat@heart-lahr.com

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