A perspective on the development of coronary revascularization

Sobel, Burton E.

doi:10.1097/mca.0b013e328337cf78

Cited by 3 publications

(1 citation statement)

References 52 publications

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“…Both accelerate coronary artery disease (CAD) and lead to premature onset of its overt manifestations. As noted in a recent review [3], coronary revascularization is used for the management of two obviously quite different conditions. The first is for treatment of chronic, symptomatic CAD in patients without an acute coronary syndrome (ACS).…”

Section: Introductionmentioning

confidence: 98%

Coronary revascularization in patients with type 2 diabetes and results of the BARI 2D trial

Sobel¹

2010

Coronary Artery Disease

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Patients with diabetes benefit from revascularization by coronary thrombolysis, percutaneous transluminal coronary angioplasty, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). However, with each intervention the benefit is less and the risks and complications are greater than in patients without diabetes. Revascularization for treatment of ST elevation myocardial infarction increases survival. When used for treatment of non-ST elevation myocardial infarction or unstable angina, it does not except in those at very high risk. In patients with chronic, symptomatic coronary artery disease, long-term mortality is comparable after CABG or PCI. However, the incidence of major adverse cardiac events is greater after PCI primarily because of the need for more subsequent revascularization procedures. Both interventions relieve symptoms, but neither improves survival except in patients at high risk. In patients with clinically stable chronic coronary disease, survival after CABG or PCI is comparable with that in patients treated with optimal medical therapy alone. Accordingly, evaluation for revascularization can be deferred until signs and symptoms worsen except in patients at high risk. In patients at high risk survival after promptly implemented CABG is greater than that with optimal medical therapy, especially when the diabetes is being treated with insulin sensitizing agents.

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Section: Introductionmentioning

confidence: 98%