Why diabetics are at risk in percutaneous coronary intervention and the appropriate management of diabetics in interventional cardiology.

The increasing prevalence of diabetes mellitus in the U.S., particularly among younger patients, will place significant additional demands on an already strained healthcare delivery system. The metabolic and hormonal milieu created by diabetes mellitus fosters the development of systemic atherosclerosis, and mortality in these patients is driven largely by complications of cardiovascular disease. Unfortunately, diabetic pathophysiology poses unique challenges to attaining successful coronary revascularization, whether it is by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). In determining the optimal treatment strategy for a diabetic patient with coronary atherosclerotic disease, it is imperative that the treating physician fully understands the following: the inherent limitations to revascularization in diabetics, the pharmacologic therapies of proven benefit in diabetics with atherosclerotic disease, the currently available comparative data of CABG versus PCI in diabetics, and the ongoing medical, surgical, and interventional advances which may render earlier data obsolete.