REVIEW

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

K P Morgan, A Kapur, K J Beatt

Imperial College, London, UK

Correspondence to:
Correspondence to:
Dr Kevin J Beatt
Department of Cardiology, National Heart and Lung Institute, Hammersmith Campus, London W12 0NN, UK; k.beatt{at}imperial.ac.uk

There are over 1.3 million known diabetic patients in the UK and a similar number who have the disease undiagnosed. Over 90% have non-insulin dependent diabetes mellitus usually characterised by insulin resistance and adult onset. Over half of all diabetic patients die of coronary disease and account for over a fifth of percutaneous coronary intervention (PCI) revascularisation procedures. Despite recent therapeutic advances such as new antiplatelet treatments and drug eluting stents, outcomes for diabetic patients after PCI are still significantly worse than for non-diabetic patients. This article summarises what is known about the pattern and severity of diabetic coronary disease, what mechanisms are responsible for these differences, and whether this information can help explain the poorer prognosis for these patients after PCI and form the basis of interventions to improve outcome.

Abbreviations: BARI 2D, bypass angioplasty revascularisation investigation; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CARDia, coronary artery revascularisation in diabetics; CASS, coronary artery surgery study; DM, diabetes mellitus; EPIC, evaluation of c7E3 Fab in the prevention of ischemic complications; EPILOG, evaluation of PTCA to improve long-term outcome with abciximab GP IIb/IIIa blockade; EPISTENT, evaluation of platelet IIb/IIIa inhibitor for stenting; IDDM, insulin dependent diabetes mellitus; MACE, major adverse cardiac events; NIDDM, non-insulin dependent diabetes mellitus; PCI, percutaneous coronary intervention; UKPDS, United Kingdom prospective diabetes study; VCAM-1, vascular cell adhesion molecule 1

Keywords: coronary artery disease; diabetes mellitus; inflammation; insulin resistance; percutaneous coronary intervention

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