Heeschen Christopher
Experimental Surgery, Department of Surgery, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany.
Diab Vasc Dis Res. 2005 Oct;2(3):122-7. doi: 10.3132/dvdr.2005.019.
Diabetic patients with acute coronary syndromes are at high risk for cardiovascular complications but risk stratification in these patients remains challenging. Regularly, diabetic patients have a less typical clinical presentation, which could lead to delayed diagnosis and subsequent delayed initiation of treatment. Since diabetic patients derive particular benefit from aggressive anti-platelet therapy, early diagnostic and therapeutic risk stratification of these patients is of critical importance to improve their adverse outcome. Although the electrocardiogram remains a pivotal diagnostic tool in the evaluation of patients suspected of having an acute coronary syndrome, only significant ST-segment changes provide reasonable prognostic information. Therefore, repeated assessment of circulating protein biomarkers represents a valuable diagnostic tool for improving efficacy and safety of decision-making in these patients. The combined use of biomarkers reflecting distinct pathophysiological aspects, such as myocardial necrosis, vascular inflammation, oxidative stress and neurohumoral activation, may significantly improve triage of patients with chest pain. These tools may identify those patients that are at particularly high risk for short-term and/or long-term cardiovascular events. Eventually, tailored medical and interventional treatment of diabetic patients should help to prevent these cardiac events in a cost-effective manner.
患有急性冠状动脉综合征的糖尿病患者发生心血管并发症的风险很高，但对这些患者进行风险分层仍然具有挑战性。通常，糖尿病患者的临床表现不太典型，这可能导致诊断延迟以及随后治疗开始延迟。由于糖尿病患者从积极的抗血小板治疗中获益尤为显著，因此对这些患者进行早期诊断和治疗风险分层对于改善其不良结局至关重要。尽管心电图仍然是评估疑似急性冠状动脉综合征患者的关键诊断工具，但只有显著的ST段改变才能提供合理的预后信息。因此，反复评估循环蛋白生物标志物是提高这些患者决策有效性和安全性的有价值诊断工具。联合使用反映不同病理生理方面的生物标志物，如心肌坏死、血管炎症、氧化应激和神经体液激活，可能会显著改善胸痛患者的分类。这些工具可以识别出那些短期和/或长期心血管事件风险特别高的患者。最终，对糖尿病患者进行有针对性的药物和介入治疗应以具有成本效益的方式帮助预防这些心脏事件。
