Motz W, Kerner W
Klinik für Kardiologie, Herz- und Diabeteszentrum Mecklenburg-Vorpommern, Greifswalder Str. 11, 17495, Karlsburg, Deutschland.
Herz. 2012 May;37(3):311-8; quiz 319-20. doi: 10.1007/s00059-012-3612-2.
Therapy of acute myocardial infarction (STEMI and NSTEMI) in diabetics does not principally differ from that of non-diabetic patients. Due to the higher mortality in diabetics reperfusion measures, such as direct percutaneous coronary intervention (PCI), should be rapidly performed. An intensive drug treatment with thrombocyte aggregation inhibitors, angiotensin-converting enzyme (ACE) inhibitors and beta-receptor blocking agents must be carried out according to the current guidelines. An important factor is the high risk of renal failure due to the contrast dye administered during PCI in the presence of pre-existing diabetic kidney damage which should be limited to 100 ml if possible. Direct PCI should be limited to the infarcted vessel. After stabilization a comprehensive strategy to cure coronary artery disease, whether with PCI or coronary artery bypass graft (CABG) should be finalized. If severe coronary 3-vessel disease is present, CABG should be favored in diabetic patients. After surviving an acute myocardial infarction differentiated metabolic monitoring is mandatory.
糖尿病患者急性心肌梗死（ST段抬高型心肌梗死和非ST段抬高型心肌梗死）的治疗原则上与非糖尿病患者并无不同。由于糖尿病患者死亡率较高，应迅速采取再灌注措施，如直接经皮冠状动脉介入治疗（PCI）。必须根据现行指南进行强化药物治疗，使用血小板聚集抑制剂、血管紧张素转换酶（ACE）抑制剂和β受体阻滞剂。一个重要因素是，在已有糖尿病肾损害的情况下，PCI过程中使用的造影剂会导致肾衰竭的高风险，如有可能，造影剂用量应限制在100毫升以内。直接PCI应限于梗死相关血管。病情稳定后，应最终确定采用PCI或冠状动脉旁路移植术（CABG）治疗冠状动脉疾病的综合策略。如果存在严重的冠状动脉三支病变，糖尿病患者应优先选择CABG。急性心肌梗死后存活的患者必须进行差异化代谢监测。
