Diabetics face more problems from PTCA
Study finds death rates 36% higher
A new study indicates that diabetics face far more complications from balloon angioplasty than the general population, partly because they have more severe and diffuse coronary artery disease.1 When looking at death rates from all causes nine years after angioplasty, researchers found that death rates were 36% for diabetics, which was double the rate for non-diabetics. The risk of myocardial infarction (MI) and the need for repeat angioplasty or coronary artery bypass graft (CABG) surgery also were considerably higher in diabetics than in non-diabetics.
"We have not appreciated how high a risk diabetics face, but it doesn’t mean they shouldn’t receive therapy; it just means that perhaps we need to develop a different treatment regimen," says David Faxon, MD, chief of the division of cardiology at the University of Southern California in Los Angeles, one of the participating centers in the study.
MI, repeat angioplasty, and death rates were determined from the medical records of 281 diabetics and 1,833 non-diabetics who were participants in the Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry from the National Heart, Lung, and Blood Institute in Bethesda, MD. The registry collects information on patients who have had PTCA at one of 16 participating medical centers.
Sheldon Goldberg, MD, professor of medicine and director of interventional cardiology at Jefferson Medical College in Philadelphia, says the study indicates that physicians should take special precautions with diabetics and ensure that the procedure is truly needed before using it. Other therapies, such as stents or the use of platelet glycoprotein Iib/IIIa receptor antagonists, should be considered when necessary.
"We still need to develop better technology to treat these patients," he says. "Right now, though, the technology is behind the biology, so we need to catch up."
Reference
1. Kip KE, Faxon DP, Detre KM, et al. Coronary angioplasty in diabetic patients. The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation 1996; 94:1,818-1,825.
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