医学
光学相干层析成像
冠状动脉疾病
血管病学
糖尿病
不利影响
内科学
经皮冠状动脉介入治疗
心脏病学
部分流量储备
易损斑块
重症监护医学
放射科
心肌梗塞
冠状动脉造影
内分泌学
作者
T. M. Hommels,Renicus S Hermanides,Enrico Fabris,Elvin Kedhi
标识
DOI:10.1186/s12933-023-01844-1
摘要
Abstract In this review, we summarise new insights into diagnostic approaches and treatment strategies for coronary artery disease (CAD) in patients with diabetes mellitus (DM). Despite the improvements in therapy, the clinical management of DM patients remains challenging as they develop more extensive CAD at a younger age and consistently have worse clinical outcomes than non-DM patients. Current diagnostic modalities as well as revascularisation treatments mainly focus on ischemic lesions. However, the impact of plaque morphology and composition are emerging as strong predictors of adverse cardiac events even in the absence of identified ischemia. In particular, the presence of vulnerable plaques such as thin-cap fibroatheroma (TCFA) lesions has been identified as a very strong predictor of future adverse events. This emphasises the need for an approach combining both functional and morphological methods in the assessment of lesions. In particular, optical coherence tomography (OCT) has proven to be a valuable asset by truly identifying TCFAs. New treatment strategies should consist of individualised and advanced medical regimens and may evolve towards plaque sealing through percutaneous treatment.
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