Differenzielle Therapie bei Diabetikern mit akutem Koronarsyndrom

Zusammenfassung

Diabetiker mit akutem Koronarsyndrom profitieren von einer frühinvasiven Abklärung und Revaskularisierung unter Anwendung von Glykoprotein-IIb/IIIa-Rezeptorantagonisten (GPIIb/IIIa-Rezeptorantagonisten). Paradoxerweise werden Diabetiker mit NSTEMI in der Praxis weniger häufig frühinvasiv behandelt und erhalten seltener GPIIb/IIIa-Rezeptorantagonisten. Zur wirksamen langfristigen Risikoverminderung bei Diabetikern nach einem akuten Koronarsyndrom gehören ein HbA_1c-Wert < 6,5 % und ein Nüchternblutzucker bis 100 mg/dl. Ein weiteres Ziel ist eine Absenkung des LDL-Cholesterinwert auf unter 70 mg/dl.

Summary

Diabetcs with the acute coronary syndrome (ACS) profit from early invasive diagnosis of their cardiac status and revascularization under cover of glycoprotein IIb/IIIa receptor inhibitors (GPRI). Paradoxically diabetics with non-ST elevation myocardial infarction (NSTEMI) in fact are less frequently treated with GPRI. To achieve long-term reduction of the risk of ACS, diabetics should have their HbA1c level kept at < 6.5% and a fasting blood glucose level up to 100 mg/dl. A further aim should be a decrease of the LDL-cholesterol value to less than 70 mg/dl.

Literatur

• 1 Cannon C P, Weintraub W S, Demopoulos L A. et al . Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban.  N Engl J Med. 2001;  344 1879-1887
• 2 Capes S E, Hunt D, Malmberg K, Gerstein H C. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes.  Lancet. 2000;  355 773-778
• 3 Dormandy J A, Charbonnel B, Eckland D J. et al.; PROactive investigators . Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial.  Lancet. 2005;  366 1279-1289
• 4 Fox K A, Poole-Wilson P, Clayton T C. et al . 5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the Britisch Heart Foundation RITA 3 randomised trial.  Lancet. 2005;  366 914-920
• 5 FRISC II Investigators . Invasive compared with non-invasive treatment in unstable coronary artery disease. FRISC II prospective randomised trial.  Lancet. 1999;  354 708-715
• 6 Hamm C W. et al . Leitlinien: Akutes Koronarsyndrom (ACS) Teil 1: Akutes Koronarsyndrom ohne persistierende ST-Hebung.  Z Kardiol (a). 2004;  93 72-90
• 7 Hamm C W et al. Leitlinien: Akutes Koronarsyndrom (ACS) Teil 2: Akutes Koronarsyndrom mit persistierender ST-Hebung.  Z Kardiol (b). 2004;  93 324-341
• 8 Malmberg K, Ryden L, Hamsten A. et al . Effects of insulin treatment on cause-specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction. DIGAMI Study Group. Diabetes Insulin-Glucose in Acute Myocardial Infarction.  Eur Heart J. 1996;  17 1337-1344
• 9 Malmberg K, Ryden L, Wedel H. et al . Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity.  Eur Heart J. 2005;  26 650-661
• 10 Peterson E D, Pollack C V, Roe M T. et al., National Registry of Myocardial Infarction (NRMI) 4 Investigators . Early use of glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute myocardial infarction: observations from the National Registry of Myocardial Infarction 4.  J Am Coll Cardiol. 2003;  42 45-53
• 11 Roffi M, Chew D P, Mukherjee D. et al . Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with non-ST-segment-elevation acute coronary syndromes.  Circulation. 2001;  104 2767-2771
• 12 UKPDS Group . Effect of intensive blood glucose control with metformin on complications in overweight patients with type 32 diabetes (UKPDS 34).  Lancet. 1998;  352 854-865