Clinical Outcomes after Triple Vessel Angioplasty in Diabetic Patients with Triple Vessel Coronary Artery Disease

Abstract

Background: This study was intended to evaluate clinical outcomes in diabetic patients who underwent triple vessel angioplasty for treatment of triple vessel coronary artery disease. Methods: This was an observational, single centred study, which included a total of 27 diabetic patients who underwent triple vessel angioplasty at a tertiary care hospital from May 2010 to July 2012. The study describes the clinical profile of the patients and a moderate term clinical follow-up to reassess the symptoms, functional status and left ventricular function by history, electrocardiogram, echocardiogram, and treadmill test. Mortality and morbidity were considered as end-points of the study. Results: Of 27 patients, 18 were males, and 55.6% were hypertensive. 70.4% of patients had normal left ventricular function. Total number lesions were 97 and the total stents implanted were 85. Event-free survival rate was 92.6% at a mean follow-up of 20.3 months. Overall 100% continued success was obtained with triple vessel angioplasty. Conclusion: Triple vessel angioplasty can be applied as favourable therapy as an alternative to surgical revascularization in selected diabetic patients. However, larger studies with long-term follow-up would warrant the effectiveness of triple vessel angioplasty in such patients. Key words: Angioplasty, Coronary Artery Disease, Diabetes, Multivessel Disease, Stents. Ashraf Safiya Manzil INTRODUCTIONGlobally, the prevalence of diabetes mellitus has been escalating since decades in affecting millions of people. 1 Diabetes poses to be a risk factor for cardiovascular disease, contributing to higher rates of myocardial infarction and cardiovascular mortality.2,3 Coexistence of diabetes and coronary artery disease (CAD) has been associated with increased mortality and morbidity, because diabetic patients have allied with larger burden of atherogenic risk factors, like hypertension, obesity, dyslipidemia, insulin resistance, elevated levels of plasma fibrinogen, 4 enhanced platelet reactivity and reduced responsiveness to antiplatelet agents. 5,6 Moreover, literature suggests that diabetics have smaller coronary vessel diameter, diffused lesions, and probably a dissimilar restenotic cascade than nondiabetic patients, thus being highly liable to atherosclerosis and having a greater requirement for undergoing repeat revascularizations, 7,8,9 thus leading to poor prognosis in such patients. 3,4,5,6,7,8,9,10 Optimal approach for treating multivessel coronary disease has been controversial 11 and triple vessel stenosis in diabetic patients make the matter worse. Though coronary artery bypass surgery (CABG) had been the conventional treatment for triple vessel disease, 12,13,14 due to presence of some limitations like angiographic features related to the extent, location, and nature of CAD, as well as geographic, demographic and clinical factors; preference of approach shifts to percutaneous coronary intervention (PCI) instead of CABG. 15 In addition, some patients have been poor candidates for CABG, lik...