Percutaneous Coronary Intervention in Diabetic Patients

Cardiovascular disease (CVD) is responsible for 30% of deaths worldwide and is the leading cause of premature mortality in patients with diabetes mellitus (DM). One of the main contributors to the increased atherothrombotic risk in DM patients relates to their pro- inflammatory and prothrombotic status that involves abnormalities in endothelial and vascular smooth muscle cells, in platelet function and the coagulation cascade. The characteristics of CAD in diabetic patients is distinctive and infers an increased risk. Likewise, CAD in diabetics is characterised by being diffuse, affecting the left main stem more frequently, involving multiple vessels, and also affecting the distal coronary tree. Percutaneous coronary intervention in diabetics has been shown to have less favourable long-term clinical outcomes, compared to non-diabetics. With the advent of improved stent designs and antiplatelet drugs; the percutaneous coronary intervention (PCI) results have improved in the diabetic population. However, one of the main determinants of poorer outcomes in DM is the progression of atherosclerosis, which is more pronounced in diabetics and remains the primary cause of cardiac events at one year follow up after percutaneous revascularisation. Whilst new generation of drug-eluting stents has narrowed the gap between surgery and PCI in diabetic patients, coronary artery bypass grafting (CABG) remains the gold standard in diabetics with diffuse multivessel coronary artery disease.