This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goldberg, S. Articles by Fischman, D. L. Search for Related Content PubMed PubMed Citation Articles by Goldberg, S. Articles by Fischman, D. L.

(Circulation. 1996;94:1804-1806.)
© 1996 American Heart Association, Inc.

Articles

The Interventional Cardiologist and the Diabetic Patient

Have We Pushed the Envelope Too Far or Not Far Enough?

Sheldon Goldberg, MD; Michael P. Savage, MD; David L. Fischman, MD

Jefferson Medical College, Philadelphia, Pa.

Correspondence to Sheldon Goldberg, MD, Division of Cardiology, Jefferson Medical College, 1025 Walnut St, Suite 410, Philadelphia, PA 19107.

Key Words: Editorials • diabetes • angioplasty

	Introduction

 
One of the greatest challenges faced by the interventional cardiologist is the mature application of clinical judgment in the optimal selection of patients for transcatheter intervention, surgical revascularization, or medical therapy. This challenge is particularly formidable in diabetic patients with obstructive coronary disease because of the difficult anatomic and biological substrate present in these patients. In this issue of Circulation, Kip et al¹ report the results of a comparison of outcomes after first-time percutaneous transluminal coronary angioplasty (PTCA) in diabetic versus nondiabetic patients for up to 9 years after entry into the NHLBI 1985-1986 PTCA Registry. This careful analysis involving a total of 2114 patients enrolled at 16 clinical sites, 281 (13%) of whom were diabetic, showed increased short- and long-term risk when balloon angioplasty was used to revascularize the ischemic myocardium in diabetic patients. An examination of the baseline clinical characteristics showed that diabetics were older and sicker than the other patients in the registry and had more frequent comorbid conditions, such as hypertension and congestive heart failure. With regard to angiographic characteristics, despite similar preserved left ventricular function (ejection fraction of 59%), diabetic patients had a greater incidence of triple-vessel disease (28% versus 18%) and more diffuse disease in both proximal and distal coronary artery segments. Despite the similarity in the number of lesions attempted, diabetic patients had a significantly higher risk of in-hospital death, nonfatal infarction, and a combined end point of death/myocardial infarction/emergency surgery. Of note, the procedural success rate was similarly low in the . . . [Full Text of this Article]

This article has been cited by other articles:

				D. L. Bhatt, S. P. Marso, A. M. Lincoff, K. E. Wolski, S. G. Ellis, and E. J. Topol Abciximab reduces mortality in diabetics following percutaneous coronary intervention J. Am. Coll. Cardiol., March 15, 2000; 35(4): 922 - 928. [Abstract] [Full Text] [PDF]