scholarly journals Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention

Heart ◽  
2004 ◽  
Vol 90 (7) ◽  
pp. 732-738 ◽  
Author(s):  
K P Morgan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Disease ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Potential Target ◽  
Percutaneous Coronary

Abstract 3760: Thiazolidinediones Do Not Reduce 1 Year Event Rates In Diabetic Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Abdul Sheikh ◽  
Khan Pohlel ◽  
Emir Veledar ◽  
Viola Vaccarino ◽  
John S Douglas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Meta Analysis ◽  
Composite Endpoint ◽  
Coronary Intervention ◽  
Similar Rate ◽  
Coronary Stenting ◽  
Diabetic Patients ◽  
Percutaneous Coronary ◽  
The Impact

Background: Thiazolidinediones (TZD) have been shown to decrease intimal hyperplasia by intravascular ultrasound after coronary stenting. However, a recent meta-analysis showed increased MI and suggested increased CV deaths with TZD use. We examined the impact of TZD use on the 1-year clinical outcomes of diabetic patients undergoing percutaneous coronary interventions. Methods: From 2000 through 2003, 598 diabetic patients underwent percutaneous coronary intervention at Emory University. Medication profiles were available for all patients who were divided into two groups: those that had a TZD as part of their diabetes regimen and those that did not. We compared the baseline clinical characteristics, angiographic characteristics, and 1 year rate of a composite endpoint of death, myocardial infarction, and revascularization between the two groups. Results: There was no difference between the two groups with regards to age, sex, baseline medical conditions, medication regimens, and overall glycemic control at the time of percutaneous coronary intervention. The lesions in both groups were of similar length, diameter, and characteristics. At 1 year the composite of death, non-fatal myocardial infarction (MI), and revascularization was not statistically different in the diabetics taking TZDs compared to those not taking TZDs (28.5% vs. 23.2%, p=0.15). There were also no differences in the rates of death and non-fatal MI. There was however a statistically significant increase in the rate of revascularization in diabetics taking TZDs compared to those not taking TZDs (25.4% vs. 17.3%, p=0.02). Conclusion: Diabetic patients undergoing coronary stenting who were on TZDs had a statistically significant increased rate of revascularization. However, there was a similar rate of the combined endpoint of death, non-fatal MI, and revascularization in all diabetic patients irrespective of TZD usages.

scholarly journals Long-Term Prognosis in Young Patients with Stable Coronary Disease: Ten-Year Follow-up of Percutaneous Coronary Intervention

2012 ◽  
Vol 20 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Igor Ribeiro de Castro Bienert ◽  
Expedito E. Ribeiro ◽  
Luiz J. Kajita ◽  
Marco Antonio Perin ◽  
Carlos A.H. Campos ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Disease ◽  
Young Patients ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Long Term Prognosis

scholarly journals Safety and efficacy of bivalirudin in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Golam Mostofa ◽  
T Parvin ◽  
R Masum Mandal ◽  
S Ali Ahsan ◽  
R Afrin
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Guide Wire ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Safety And Efficacy ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Hemorrhagic Complications

Abstract Background Prevention of hemorrhagic complications has emerged as a priority in patients undergoing Percutaneous Coronary Intervention (PCI) in addition to suppressing thrombotic complications. This goal is challenging to achieve in diabetic Acute Coronary Syndrome (ACS) patients as Diabetes Mellitus (DM) itself is a prothrombotic state with more pronounced vascular injury response and have a worse outcome after PCI compared with non-diabetic patients. In patients with ACS, Bivalirudin has been shown to result in similar rates of composite ischemia as Heparin plus GPI (GP IIb /IIIa inhibitor), while significantly reducing major bleeding and has received class I recommendation for PCI by American College of Cardiology (ACC 2013). Whether Bivalirudin is safe and effective specially in diabetic ACS patients undergoing PCI, as compared with Heparin (UFH) monotherapy, is unknown. Purpose To determine and compare the incidence of in-hospital and 30-day hemorrhagic complications and major adverse cardiac events (MACEs) as evidence of safety and efficacy using Bivalirudin versus Heparin in diabetic ACS patients undergoing PCI. Methods 218 diabetic ACS patients (age>18 years and ≤75 years) who underwent PCI from May 2018 to April 2019 at University Cardiac Centre, BSM Medical University, Dhaka, Bangladesh were randomly assigned to have UFH or Bivalirudin. Before the guide wire crossed the lesion, 111 patients in the UFH group received a bolus of 70–100 U/kg (targeted activated clotting time, ACT: 200–250 s). 107 patients in the Bivalirudin group received a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors (Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complications and MACEs [death, MI, target vessel revascularization (TVR) and stroke]. Results Patients treated with Bivalirudin compared with Heparin had a significantly lower in-hospital incidence of QMI (0% vs. 6%; p=0.03) and major bleeding (0% vs. 7%; p=0.02). However, the incidence of cardiac death, stent thrombosis, TVR were no differences between two groups (p>0.05). There was only one NQMI in the Bivalirudin group as opposed to 8% in the Heparin group in 30 days following stenting (p=0.04). Conclusion In diabetic ACS patients undergoing PCI, Bivalirudin is safe and effective as it reduces immediate and short-term hemorrhagic complications as well as MACEs as compared with Heparin. FUNDunding Acknowledgement Type of funding sources: None.

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