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Aktuelle Kardiologie 2019; 8(04): 274-279
DOI: 10.1055/a-0892-0732
Kurzübersicht
Georg Thieme Verlag KG Stuttgart · New York

Myokardiale Revaskularisation bei Patienten mit Diabetes mellitus

Myocardial Revascularization in Patients with Diabetes Mellitus
Paul Michael Haller
Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH, Allgemeine und Interventionelle Kardiologie
,
Dirk Westermann
Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH, Allgemeine und Interventionelle Kardiologie
› Author Affiliations
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Publication History

Publication Date:
15 August 2019 (online)

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Zusammenfassung

Patienten mit Diabetes mellitus stellen eine wesentliche Subgruppe aller Patienten mit koronarer Herzkrankheit dar. Unter anderem aufgrund des diabetesbedingten, oftmals aggressiven Voranschreitens der koronaren Herzkrankheit präsentiert sich diese Patientengruppe gewöhnlich mit einer komplexen Koronarmorphologie, unter anderem mit Befall mehrerer Gefäße und gegebenenfalls auch einer Beteiligung des linken Hauptstamms. Die Prognose dieser Patienten ist verglichen mit Patienten ohne Diabetes mellitus außerdem deutlich schlechter. Entsprechend herausfordernd ist die richtige Wahl der koronaren Revaskularisation bei symptomatischen Patienten. Zumal die meisten Patienten mit Diabetes mellitus einen Befall mehrerer Herzkranzgefäße aufweisen, sollte die Entscheidung über das weitere Vorgehen auf einer interdisziplinären Diskussion im Heart-Team beruhen. Denn vor allem im Langzeitverlauf profitieren Patienten mit Diabetes mellitus von einer Versorgung mittels aortokoronaren Bypasses, was sich mit einer Reduktion der Gesamtsterblichkeit und einer geringeren Rate an Myokardinfarkten zeigt.

Abstract

Patients with diabetes mellitus represent a large subpopulation of patients with coronary artery disease. Commonly, diabetes mellitus leads to an aggressive progression of coronary artery disease, wherefore patients often present with complex diseased vessels, usually involving multiple coronaries and potentially also the left main. Besides, the prognosis of patients with compared to without diabetes mellitus is usually worse. Hence, the right choice of coronary revascularization in symptomatic patients is challenging. In such case, the decisions should be based on an interdisciplinary discussion in the “Heart-Team”. Because, especially in the long-term course patients will benefit from aortocoronary bypass surgery, which is associated with a reduction of all-cause mortality and the incidence of myocardial infarction.

Was ist wichtig?

  • Die optimale Koronarversorgung von Patienten mit DM ist oftmals herausfordernd und wird unter anderem durch ein breites kardiovaskuläres Risikoprofil sowie eine meist progressive KHK mit (diffusem) Befall mehrerer Koronarien verkompliziert.

  • Zahlreiche Studien zeigen einen Vorteil im Langzeitverlauf zugunsten einer ACBP für die Versorgung von Patienten mit DM und Mehrgefäßerkrankung.

  • Essenziell ist der interdisziplinäre Diskurs unter Betrachtung der Komorbiditäten, der Koronarmorphologie und der OP-Tauglichkeit, um eine für den Patienten optimale Empfehlung auszusprechen.

Schlüsselwörter

myokardiale Revaskularisation - koronare Herzerkrankung - perkutane Koronarintervention - aortokoronarer Bypass - Diabetes mellitus

Key words

myocardial revascularization - coronary artery disease - percutaneous coronary intervention - coronary artery bypass surgery - diabetes mellitus
 

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