open access

Vol 8, No 2 (2007): Practical Diabetology
Review articles (submitted)
Published online: 2007-03-02
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Acute coronary syndromes - management in diabetes mellitus

Kajetan Poprawski
Diabetologia Praktyczna 2007;8(2):41-49.

open access

Vol 8, No 2 (2007): Practical Diabetology
Review articles (submitted)
Published online: 2007-03-02

Abstract

Patients with acute coronary syndrome (ACS) and concomitant diabetes mellitus (DM), belonging to a very high risk group, constitute a challenge for therapeutic team. They need more 'aggressive' therapy: intensive insulinotherapy (intravenous infusion in the first day, and multiple subcutaneous injections from the second day to the end of the third month), metabolic compensation, the earliest coronary reperfusion, the use of antiplatelet (acetylsalicylic acid, clopidogrel, glycoprotein IIb/IIIa inhibitors) and anticoagulant agents (heparin). In patients with ST-elevation ACS (STE-ACS), lasting < 12 hours, primary percutaneous coronary intervention (PCI) with stent implantation is recommended. If the time from the onset of chest pain is < 3 hours, thrombolysis is suggested. In the event of ineffective trombolysis, a rescue PCI is proposed. After effective thrombolysis, a delayed PCI should be performed during the first week, if there is the culprit vessel stenosis and rest or inducible ischemia. In patients with STE-ACS and higher risk (with DM, among others), secondary PCI (after thrombolysis) is recommended - rescue, early or facilitated PCI. In non-ST-elevation ACS (NSTE-ACS) patients at higher risk, including ones with DM, invasive strategy is advised: early or immediate PCI together with GPI IIb/IIIa; however, in patients with low risk, conservative strategy is proposed at first, and later the result of stress testing decides about qualification to PCI or non-invasive therapy. In ACS and DM, β-blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonist, statins and/or fibrates should be applied as well. In most cases, cooperation of cardiologist and diabetes specialist is mandatory.

Abstract

Patients with acute coronary syndrome (ACS) and concomitant diabetes mellitus (DM), belonging to a very high risk group, constitute a challenge for therapeutic team. They need more 'aggressive' therapy: intensive insulinotherapy (intravenous infusion in the first day, and multiple subcutaneous injections from the second day to the end of the third month), metabolic compensation, the earliest coronary reperfusion, the use of antiplatelet (acetylsalicylic acid, clopidogrel, glycoprotein IIb/IIIa inhibitors) and anticoagulant agents (heparin). In patients with ST-elevation ACS (STE-ACS), lasting < 12 hours, primary percutaneous coronary intervention (PCI) with stent implantation is recommended. If the time from the onset of chest pain is < 3 hours, thrombolysis is suggested. In the event of ineffective trombolysis, a rescue PCI is proposed. After effective thrombolysis, a delayed PCI should be performed during the first week, if there is the culprit vessel stenosis and rest or inducible ischemia. In patients with STE-ACS and higher risk (with DM, among others), secondary PCI (after thrombolysis) is recommended - rescue, early or facilitated PCI. In non-ST-elevation ACS (NSTE-ACS) patients at higher risk, including ones with DM, invasive strategy is advised: early or immediate PCI together with GPI IIb/IIIa; however, in patients with low risk, conservative strategy is proposed at first, and later the result of stress testing decides about qualification to PCI or non-invasive therapy. In ACS and DM, β-blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonist, statins and/or fibrates should be applied as well. In most cases, cooperation of cardiologist and diabetes specialist is mandatory.
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Keywords

acute coronary syndrome; diabetes mellitus; intensive insulinotherapy; coronary reperfusion; antiplatelets agents; β-blockers; angiotensin converting enzyme inhibitors; statins; fibrates

About this article
Title

Acute coronary syndromes - management in diabetes mellitus

Journal

Clinical Diabetology

Issue

Vol 8, No 2 (2007): Practical Diabetology

Pages

41-49

Published online

2007-03-02

Bibliographic record

Diabetologia Praktyczna 2007;8(2):41-49.

Keywords

acute coronary syndrome
diabetes mellitus
intensive insulinotherapy
coronary reperfusion
antiplatelets agents
β-blockers
angiotensin converting enzyme inhibitors
statins
fibrates

Authors

Kajetan Poprawski

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