Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Canada; Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ICES, Toronto, Canada.
Prog Cardiovasc Dis. 2019 Jul-Aug;62(4):358-363. doi: 10.1016/j.pcad.2019.07.004. Epub 2019 Aug 1.
Patients with diabetes mellitus (DM) often exhibit a complex coronary anatomy, making coronary revascularization challenging. Coronary artery bypass grafting surgery (CABG) is currently considered the preferred revascularization method in patients with DM and multivessel disease. Percutaneous coronary intervention (PCI) has advanced with new stent generations having been developed in the recent years, but they have not yet been adequately compared against CABG in the population with DM. Comorbidities, such as renal disease and heart failure, lead to worse prognosis following a revascularization procedure and require especial consideration when choosing between CABG versus PCI. The presence of significant left main disease may also impose additional challenges to coronary revascularization, particularly when accompanied by the involvement of multivessel disease. Most of the evidence regarding revascularization in patients with DM is compiled from studies enrolling patients with stable ischemic heart disease, and trials with patients in the acute coronary syndrome setting are lacking.
糖尿病（DM）患者常表现出复杂的冠状动脉解剖结构，使冠状动脉血运重建具有挑战性。冠状动脉旁路移植术（CABG）目前被认为是糖尿病和多支血管疾病患者首选的血运重建方法。近年来，随着新一代支架的发展，经皮冠状动脉介入治疗（PCI）也取得了进展，但在糖尿病患者中，它们尚未与 CABG 进行充分比较。合并症，如肾病和心力衰竭，会导致血运重建后预后更差，因此在选择 CABG 与 PCI 时需要特别考虑。严重的左主干病变的存在也可能对冠状动脉血运重建带来额外的挑战，尤其是当伴有多支血管疾病时。关于糖尿病患者血运重建的大多数证据都来自于招募稳定型缺血性心脏病患者的研究，而急性冠状动脉综合征患者的试验则缺乏。
