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DOI: 10.1055/a-2321-1534
Komplexe koronare Herzerkrankung und Diabetes
Complex Coronary Artery Disease and Diabetes mellitusZusammenfassung
Im Vergleich zur Normalpopulation haben Patienten mit Diabetes mellitus ein signifikant höheres kardiovaskuläres Risiko. Dies beinhaltet eine erhöhte kardiovaskuläre Ereignisrate sowohl vor einer Koronarintervention im Nativgefäß als auch postinterventionell im mit einem Stent versorgten Gefäßsegment. Entsprechend anspruchsvoll ist die optimale Revaskularisationsstrategie bei Diabetes und Vorliegen eines komplexen Koronarbefunds. Gerade bei einer koronaren Mehrgefäßerkrankung scheint die aortokoronare Bypassoperation bei Diabetikern einer perkutanen Koronarintervention überlegen zu sein, wohingegen die Datenlage bei koronarer Hauptstammbeteiligung und beim akuten Koronarsyndrom noch uneinheitlich ist.
Abstract
Patients with diabetes mellitus represent, compared to the overall population, a cohort with significantly increased cardiovascular risk. This includes a higher rate of cardiovascular events, both before the coronary intervention in the native coronary vessel as well as postinterventionally in the stented coronary segment. Thus, the revascularisation strategy in patients with diabetes and concurrent complex coronary anatomy can be extremely challenging. However, particularly in multi-vessel disease CABG appears to be superior towards PCI, while data concerning left main stem and acute coronary syndrome remain currently controversial.
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Patienten mit Diabetes mellitus haben ein erhöhtes kardiovaskuläres Risiko und eine in der Regel komplexere Anatomie der koronaren Herzerkrankung.
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Neben dem Stenosegrad spielt zunehmend auch die Plaquemorphologie von Koronargefäßen eine wichtige Rolle. Oftmals findet sich ein vulnerabler rupturgefährdeter Plaque in angiografisch eher milden Stenosen.
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Die optimale Revaskularisationsstrategie bei komplexer koronarer Herzerkrankung und Diabetes ist abhängig von Ausmaß, Schweregrad und Lokalisation der Koronarstenose.
Publication History
Article published online:
31 July 2024
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