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Aktuelle Kardiologie 2018; 7(04): 301-307
DOI: 10.1055/a-0649-6852
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Diabetes und Revaskularisation

Diabetes and Revascularization
Sebastian Reith
1   Medizinische Klinik I, Universitätsklinikum der RWTH Aachen
,
Volker Schächinger
2   Medizinische Klinik I, Klinikum Fulda
› Author Affiliations
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Publication History

Publication Date:
24 August 2018 (online)

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Zusammenfassung

Patienten mit Diabetes mellitus haben im Vergleich zur Normalpopulation ein signifikant erhöhtes Risiko, kardiovaskuläre Ereignisse zu erleiden. Durch spezifische diabetesassoziierte pathophysiologische Veränderungen schreitet die koronare Atherosklerose bei Patienten mit Diabetes mellitus in der Regel schneller und diffuser voran. Mithilfe des SYNTAX-Scores können der morphologische Schweregrad der koronaren Herzerkrankung graduiert und somit die optimale Revaskularisationsstrategie festgelegt werden. Diabetische Patienten mit einer komplexen Koronar- und Stenoseanatomie profitieren, sofern das operative Risiko vertretbar ist, am ehesten von einer aortokoronaren Bypassoperation. Bei weniger komplexer KHK stellt die perkutane Koronarintervention eine valide Therapiealternative dar, hier sollten heutzutage aber ausschließlich medikamentenbeschichtete Stents der 2. Generation verwendet werden.

Abstract

In contrast to a general patient population patients with diabetes mellitus exhibit a significantly enhanced risk of subsequent cardiovascular events. Due to a frequently inadequate glucose control and due to diabetes-associated pathophysiologic abnormalities the progress of coronary atherosclerosis in patients with diabetes mellitus is faster and more diffuse. The SYNTAX Score enables the validation of the morphologic extent of the coronary artery disease und allows the decision for the best revascularisation strategy. Patients with diabetes and a complex anatomy of both, the coronary vessels as well as the stenosis, particularly benefit from coronary artery bypass graft, whereas in cases with less complex coronary artery disease percutaneous coronary intervention may be a suitable alternative. In the latter the use of drug eluting stents of the 2nd generation is highly recommended.

Was ist wichtig?

  • Patienten mit Diabetes mellitus (DM) Typ I oder Typ II haben ein deutlich erhöhtes Risiko, an kardiovaskulären Erkrankungen wie Myokardinfarkt, Schlaganfall oder Herzinsuffizienz zu erkranken.

  • Das Management bei Patienten mit DM beinhaltet neben zahlreichen Strategien der kardiovaskulären Risikoreduktion insbesondere auch verschiedene interventionelle Therapieoptionen, namentlich die aortokoronare Bypassoperation (coronary artery bypass graft, CABG) sowie die perkutane Koronarintervention (percutaneous coronary intervention, PCI). Die ideale Therapiestrategie kann sich durchaus vom therapeutischen Vorgehen bei Patienten ohne DM unterscheiden.

  • Durch die Tatsache, dass DM Typ II sehr viel häufiger auftritt und darüber hinaus weltweit stetig zunimmt, gibt es inzwischen für dieses Kollektiv eine Vielzahl an Daten und Publikationen, wohingegen für Patienten mit DM Typ I und koronarer Herzerkrankung (KHK) nur eine sehr begrenzte Evidenz vorliegt.

  • Entsprechend liegt der Fokus dieses Artikels ausschließlich auf Patienten mit Typ-II-Diabetes.

Schlüsselwörter

Diabetes mellitus - SYNTAX - perkutane Koronarintervention - aortokoronare Bypassoperation

Key words

diabetes mellitus - SYNTAX - percutaneous coronary intervention - aortocoronary bypass surgery
 

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