Dr. Roxana Mehran,
Prof. Stuart Head
Stent thrombosis more likely in diabetics.
View the Slides from this session in ESC Congress 365
This 90-minute session was dedicated to the diabetic patient with cardiovascular disease (CAD) and revascularization strategies. Diabetic patients are at high risk for accelerated atherosclerosis, thrombosis, restenosis, and aggressive progression of CAD.
These risk factors make the revascularization choices difficult for clinicians. With the current data, diabetic patients with severe symptomatic complex CAD should be referred to CABG. The session discussed in detail the controversies from the FREEDOM study, which include late separation of event curves beyond the expected one year for death/MI/CVA, as well as the number of patients with available late follow up. Given all the controversies, the FREEDOM trial remains the largest trial dedicated to patients with DM and complex CAD referred for revascularization therapy. Despite initial excess in events after CABG versus PCI, and a relative equipoise for a first few years, CABG has provided an event-free survival advantage in this population at 3-5 year follow-up. In generalizing these results, attention should be paid to the types of patients enrolled.
Speakers discussed the pathobiology of vessel wall and the ongoing inflammatory process of the diabetic patient, which may impact both revascularization strategies. Both strategies are associated with higher event rates compared to non-diabetic patients. The importance of vessel patency and the impact of internal mammary artery use with its great patency and ability to protect against progression of CAD beyond the original lesion was discussed.
The panel discussed the shortcomings of both revascularization strategies. The future will be focused on improving medical therapy and reaching goals for risk factor modification (HTN, Hypercholesterolemia, and glycemic control), as well as improved revascularization techniques both in CABG (more arterial revascularization), and PCI (FFR guided PCI, and next generation DES).
Finally, we discussed individualizing revascularization strategies for patients with DM, using risk scores like the EuroSCORE and SYNTAX score. However, the complexity of the decisions was highlighted, concluding that the Heart Team remains essential in decision-making.
Which diabetic patients are eligible for PCI?
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