Legrand Victor
Service de Cardiologie, CHU de Liège Sart-Tilman, 4000 Liège, Belgium.
Nat Clin Pract Cardiovasc Med. 2007 Mar;4(3):143-50. doi: 10.1038/ncpcardio0804.
Individuals with diabetes mellitus usually present with accelerated atherosclerosis, more diffuse disease, concomitant comorbidities and have an increased risk for restenosis. Evidence confirmed the superiority of CABG surgery over balloon angioplasty with or without bare-metal stenting for diabetic patients requiring multivessel revascularization. More recently, drug-eluting stents (DESs) have emerged as the predominant percutaneous strategy in patients with coronary artery disease. This Review summarizes the knowledge on coronary stenting in diabetics. Although the rate of restenosis is dramatically reduced with the use of DESs compared with bare-metal stents, diabetic patients continue to face higher adverse cardiac event rates when compared with nondiabetic patients. Whether there are differences in the effectiveness of paclitaxel-eluting or sirolimus-eluting stents is still debated. Late outcome might be overshadowed by clinical issues such as late stent thrombosis or restenosis, particularly in diabetic patients with renal failure or complex lesions, and after premature interruption of antiplatelet agents. Longer follow-up in larger populations is thus needed to confirm the long-term safety and efficacy. The superiority or the equivalence of DESs over CABG surgery for multivessel disease has not yet been demonstrated. Thus, although evidence supports DES use in diabetics, further data are needed to better define the management of diabetic patients with coronary artery disease.
糖尿病患者通常表现为动脉粥样硬化加速、疾病更为弥漫、伴有合并症，且再狭窄风险增加。有证据证实，对于需要进行多支血管血运重建的糖尿病患者，冠状动脉旁路移植术（CABG）优于单纯球囊血管成形术或联合裸金属支架置入术。最近，药物洗脱支架（DES）已成为冠心病患者主要的经皮治疗策略。本综述总结了糖尿病患者冠状动脉支架置入术的相关知识。尽管与裸金属支架相比，使用DES可显著降低再狭窄率，但与非糖尿病患者相比，糖尿病患者仍面临更高的不良心脏事件发生率。紫杉醇洗脱支架和西罗莫司洗脱支架的有效性是否存在差异仍存在争议。晚期结局可能会受到诸如晚期支架血栓形成或再狭窄等临床问题的影响，特别是在患有肾衰竭或复杂病变的糖尿病患者中，以及在过早中断抗血小板药物治疗后。因此，需要在更大规模人群中进行更长时间的随访，以确认其长期安全性和有效性。DES在多支血管病变中相对于CABG手术的优越性或等效性尚未得到证实。因此，尽管有证据支持在糖尿病患者中使用DES，但仍需要更多数据来更好地确定冠心病糖尿病患者的治疗方案。
