Diabetes and Percutaneous Interventional Therapy

With the aging of the US population and increasing prevalence of both diabetes and coronary artery disease (CAD), the number of interventional coronary and peripheral arterial procedures has markedly increased in an attempt to prevent morbid and mortal events. Unfortunately, the cardiovascular mortality of the diabetic patient remains high; the risk of a myocardial infarction (MI) at 7 years is equivalent for the diabetic without CAD and the nondiabetic who has already suffered an MI (1). It has been estimated that the spontaneous risk of MI in diabetics with three-vessel disease is 10% to 15% per year (2). Total mortality after this MI is higher than in the nondiabetic population. Over the last two decades, the number of diabetics undergoing percutaneous coronary intervention (PCI) has doubled, and the age, lesion complexity, and proportion of unstable patients has increased (3).