Patienten mit Diabetes mellitus und koronarer Herzkrankheit

ZUSAMMENFASSUNG

Patienten mit Diabetes mellitus sind häufiger von einer koronaren Herzerkrankung betroffen, zudem weisen sie einen komplexeren Koronarstatus auf. In verschiedenen Studien wurden Diabetiker bezüglich der optimalen Revaskularisationsstrategie untersucht. Die operative Myokardrevaskularisation war der interventionellen Strategie vor allem bei koronarer 3-Gefäßerkrankung mit hohem Syntax-Score überlegen. Gezeigt werden konnte ebenso, dass die perkutane Koronarintervention bei Läsionen mit einem niedrigen Syntax-Score der chirurgischen Bypass-Operation mindestens gleichwertig ist und somit aufgrund der geringeren Invasivität bevorzugt werden muss. Die Entscheidung zur optimalen Revaskularisationsstrategie basiert somit auf der angiografischen Untersuchung, welche bei komplexen Befunden durch die Bestimmung der fraktionellen Flussreserve ergänzt werden sollte. Im Alltag müssen Komorbiditäten des Patienten (welche Ausschlusskriterien für die Studien sind) wie z.B. hochgradig reduzierte linksventrikuläre Pumpfunktion und pulmonale Erkrankungen immer in Betracht gezogen werden um die individuell beste Behandlungsstrategie zu formulieren.

• 1 Homepage des statistischen Bundesamtes:. https://www.destatis.de/DE/Startseite.html (Aufruf: 22.02.2017)
• 2 Kolh P. Windecker S. Alfonso F. et al. Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery; European Association of Percutaneous Cardiovascular Interventions. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).. Eur J Cardiothorac Surg 2014; 46: 517-592
• 3 Nicholls SJ. Tuzcu EM. Crowe T. et al. Relationship between cardiovascular risk factors and atherosclerotic disease burden measured by intravascular ultrasound. J Am Coll Cardiol 2006; 47: 1967-1975
• 4 Kip KE. Alderman EL. Bourassa MG. et al. Differential influence of diabetes mellitus on increased jeopardized myocardium after initial angioplasty or bypass surgery: bypass angioplasty revascularization investigation. Circulation 2002; 105: 1914-1920
• 5 Wenaweser P. Daemen J. Zwahlen M. et al. Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study. J Am Coll Cardiol 2008; 52: 1134-1140
• 6 Thourani VH. Weintraub WS. Stein B. et al. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg 1999; 67: 1045-1052
• 7 Whang W. Bigger Jr JT. Diabetes and outcomes of coronary artery bypass graft surgery in patients with severe left ventricular dysfunction: results from The CABG Patch Trial database. The CABG Patch Trial Investigators and Coordinators. J Am Coll Cardiol 2000; 36: 1166-1172
• 8 The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996; 335: 217-225 [Erratum, N Engl J Med 1997; 336:147]
• 9 Farkouh ME. Domanski M. Sleeper LA. et al. FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367: 2375-2384
• 10 Mohr FW. Morice MC. Kappetein AP. et al Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381: 629-638
• 11 Ahn JM. Roh JH. Kim YH. et al. Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study. J Am Coll Cardiol 2015; 65: 2198-2206
• 12 Sabate M. Cequier A. Iniguez A. et al. Everolimus-eluting stent versus bare-metal stent in ST-segment elevation myocardial infarction (EXAMINATION): 1 year results of a randomised controlled trial. Lancet 2012; 380: 1482-1490
• 13 Lamy A. Devereaux PJ. Prabhakaran D. et al. CORONARY Investigators. Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. N Engl J Med 2016; 375: 2359-2368
• 14 Taggart DP. Altman DG. Gray AM. et al. ART Investigators. Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts. N Engl J Med 2016; 375: 2540-2549
• 15 Bangalore S. Guo Y. Samadashvili Z. et al. Everolimus Eluting Stents Versus Coronary Artery Bypass Graft Surgery for Patients With Diabetes Mellitus and Multivessel Disease. Circ Cardiovasc Interv 2015; 8: e002626
• 16 Stone GW. Sabik JF. Serruys PW. et al. EXCEL Trial Investigators. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med 2016; 375: 2223-2235
• 17 Mäkikallio T. Holm NR. Lindsay M. et al. NOBLE study investigators. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 2016; 388: 2743-2752
• 18 Pijls NH. Fearon WF, Tonino PA. et al. FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol 2010; 56: 177-184
• 19 De Bruyne B. Fearon WF. Pijls NH. et al. FAME 2 Trial Investigators. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med 2014; 371: 1465