© 2002 by Heart
EDITORIAL
Percutaneous coronary intervention in diabetics: time to consider "intimal remodelling therapy"?
Correspondence to:
Correspondence to:
Dr Peter F Ludman, Cardiology Department, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham B15 2TH, UK;
p.f.ludman@bham.ac.uk
Can "intimal remodelling therapy" by percutaneous coronary intervention improve the otherwise poor prognosis of diabetic patients with severe diffuse multivessel disease?
Keywords: percutaneous coronary intervention; diabetics; revascularisation; intimal remodelling therapy
Abbreviations: ARTS, arterial revascularisation study; BARI, bypass angioplasty revascularization investigation; CABRI, coronary angioplasty versus bypass revascularisation investigation; CABG, coronory artery bypass graft; EAST, Emory angioplasty versus surgery trial; HDL, high density lipoprotein; IMA, internal mammary artery; LDL, low density lipoprotein; PCI, percutaneous coronary intervention; RITA, randomised intervention treatment of angina
| The first 150 words of the full text of this article appear below. |
An apparently inexorable sequence of remarkable developments in the techniques of percutaneous coronary intervention (PCI) have led to this method being poised to become the dominant tool for coronary revascularisation. Nevertheless, interventional cardiologists will not be able to make this claim until we can be confident about the best management strategy for patients with diabetes and multivessel coronary disease.
Diabetes is a vascular disease. Patients with both type 1 and type 2 diabetes carry the burden of a high incidence of premature fatal macrovascular disease. Type 2 diabetes, best described as a cluster of risk factors for cardiovascular disease (insulin resistance, dyslipidaemia, obesity, hypertension) is associated with a reduction in life expectancy of 8–10 years in the 40–70 year age range.1 Type 1 diabetes is rather different. It is not associated with other classical cardiovascular risk factors. Indeed the normal or low triglyceride concentrations, normal or high HDL (high density
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