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Posebnosti kirurškega zdravljenja koronarne bolezni pri bolnikih s sladkorno boleznijo = Surgical treatment of coronary artery disease in diabetic patients
Brecelj, Aleš, 1946-
Diabetes mellitus promotes the development of coronary artery disease and heart failure. Coronary artery disease is a late complication of diabetes mellitus, reflecting involvment of the micro- and ...macrocirculation. Cardiovascular manifestations of diabetes mellitus include accelerated atherosclerosis, atypical ischaemic pain, silent myocardial infarction and autonomic neuropathy. Diabetes mellitus as an independent risk factor increasis morbidity and mortality following coronary artery bypass surgery by 16.7%. Compared to other patients undergoing surgery, diabetic subjects show amore diffuse involvment of their coronary vessels and therefore require more endarterectomies. The indications for myocardial revascularisation in diabeticpatients are the same as in nondiabetic subjects. Coronary bypass surgery is considered in patients who do not benefit from drug treatment and do not meet the criteria for percutaneus transluminal coronary angioplasty andintracoronary stent implantation. The indications for surgical revascularisation are: three-vessel disease, main artery stenosis, two-vessel disease involving the proximal segment of the left anterior coronary artery, and two-vessel disease with poor left ventricular function. The management of coronary artery disease in diabetic patients could be improved by earlier detection and better understanding of the pathophysiological processes underlying the effect of diabetes mellitus on coronary artery disease development and treatment. This could be achieved by improving the accuracy ofnon-invasive diagnostic procedures. The main effort, however, should be aimed at preventing the development of coronary artery disease.
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