Herz
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This review summarizes some information on the management of diabetic patients at risk for or with already established coronary artery disease. Improved knowledge among diabetologists regarding treatment and prevention of cardiovascular complications and among cardiologists regarding diabetology is a prerequisite for progress to be made for patients with diabetes mellitus with cardiovascular disease. ⋯ The high costs associated with the management of diabetic patients with coronary artery disease suggest that improved primary and secondary prevention very likely will be cost-effective. Reference is made to the recently published European guidelines for diabetes, prediabetes and cardiovascular disease issued by the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD).
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Review Comparative Study
[Drug-eluting stents for diabetic patients. A critical appraisal of the currently available data from randomized trials].
Patients with coronary artery disease (CAD) and diabetes mellitus represent a peculiar high-risk population because of their specific characteristics of atherosclerotic disease. In conjunction with the diabetes-related comorbidities, percutaneous coronary intervention (PCI) often leads not only to a worse acute result but - also as compared to nondiabetics - to significantly worse long-term results due to the higher restenosis rates. The rapid introduction of effective drug-eluting stents (DES), which undoubtedly reduce the restenosis rates as compared with bare-metal stents (BMS), brought great hope of providing diabetic patients better and longer-lasting interventional solutions. This overview compiles the currently available data from randomized trials and meta-analyses. ⋯ Of the 22 DES having received a CE certificate, long-term data over 5 years for patients with diabetes are available only for the Cypher and the Taxus stents. Compared with BMS, patients with diabetes and their characteristically small vessels and long lesions predominantly benefit from effective DES. The sometimes postulated differences between Cypher and Taxus in diabetic patients could not be convincingly demonstrated; larger randomized trials with a primary clinical endpoint are required for this. PCI cannot be considered a scientifically sound and evidence- based alternative to bypass surgery in diabetic patients with multivessel disease and/or unprotected left main stenosis until we have the results of the SYNTAX, COMBAT and FREEDOM trials.