Analysis of recurrent revascularization events following percutaneous coronary intervention of diabetic patients.

AIM: Greater incidence of recurrent events following percutaneous coronary intervention (PCI) has been described among patients with diabetes mellitus (DM). A clear actual picture of these events can hitherto be considered as lacking. Aim of this study was to describe frequency and peculiarity of recurrent cardiovascular events following PCI in a group of high risk DM patients and to compare the impact of repeat PCI and/or surgical revascularizations on the need of further coronary interventions in a long-term follow-up. METHODS: 254 consecutive DM patients undergoing PCI for known coronary artery disease (CAD) were followed by outpatient visits for 39+/-9 months. The registered endpoints were target vessel PCI (TVR PCI), target vessel surgical revascularizations (TVR CABG), non target vessel percutaneous revascularization interventions (NON TVR PCI), and no repeat revascularizations. RESULTS: 74 (35%) of the DM patients undergoing an index PCI required further revascularization and 10 (17%) patients needed more than one repeat TVR procedure. Second TVR revascularisation procedures occurred similarly following first PCI (15%) or surgical revascularisation (17%) driven by coronary lesions located in epicardial vessels treated during the index PCI. Patients undergoing TVR surgical revascularisation disclosed a higher probability of incurring in a second PCI driven by coronary lesions located in epicardial vessels not previously treated (P=0.003) compared to those approached by PCI. CONCLUSIONS: The present study reports on a seemingly superior coronary protection of PCI compared to surgical revascularization in preventing disease progression upon the native coronary arteries. These results need confirmation in larger population samples.

Clinical and pharmacological management of a high risk diabetic population undergoing percutaneous coronary interventions.

AIM: An optimal clinical management and monitoring of patients with diabetes mellitus (DM) and coronary artery disease (CAD) has proved to reduce the incidence of cardiovascular events. The main aim of this report is to verify the adherence to the latest guidelines recommendations in a considerable group of DM patients undergoing a percutaneous coronary intervention, stratifying the population by the degree of the DM management. METHODS: The patients recruited were those consecutive, unselected patients with type 2 DM undergoing a balloon angioplasty followed by a stent implantation, between July 2002 and December 2004. Follow-up was completed in 220 patients at 39+/-8.7 months. The follow-up interview concerned sociodemographic details, medical history, pharmaceutical treatment, major adverse cardiac and cerebrovascular events and clinical variables regarding the quality of DM management and monitoring. RESULTS: Thirty-six percent of these high short and long-term risk patients received insulin treatment at index hospitalization despite a poor glucometabolic control (59% presented HbA1c >7%, mean 8+/-1.26%). The clinical management of the 204 (80%) survivors over time proved overall unsatisfactory: HbA1c, arterial blood pressure and body mass index uncommonly achieved the recommended targets (41%, 36% and 22% of the patients respectively). The DM monitoring revealed satisfactory, with the exception of the diabetic foot monitoring (performed in 38% of the patients). Concerning guideline adherence 26% of the patients proved to adhere strictly, while 38% and 36% were mildly and severely distant from these requirements. CONCLUSION: Quality of DM management absolutely necessitates to be improved to attempt reducing the high cardiovascular event rates.