关键词: 糖尿病, 冠状动脉疾病, 经皮冠状动脉介入治疗, 冠状动脉搭桥术, 抗血小板药物, 氯吡格雷, 药物洗脱支架

Abstract: Morbidity and mortality related to CAD remain a great challenge in patients with DM.Platelet function is abnormal in diabetes,expression of both glycoprotein Ib and Ⅱb/ Ⅲa is increased,augmenting both platelet-von Willebrand factor and platelet-fibrin interaction which leads to an increased risk of death and thrombotic complications in diabetics compared with nondiabetic patients.Multiple studies have shown that DM is a strong risk factor for restenosis following successful percutaneous coronary intervention (PCI) with greater need for repeat revascularization and inferior clinical outcomes though early data available suggest that drug eluting stents (DES) reduce restenosis rates and the need for repeat revascularization irrespective of the diabetic state and with no significant reduction in hard clinical endpoints such as myocardial infarction and mortality.However,there are so many other randomized trials comparing multivessel PCI using DES or bare metal stent (BMS) to coronary artery bypass grafting (CABG) which consistently demonstrated the superiority of CABG in patients with DM.Selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial.Strategies for revascularization must take into account the higher risk for restenosis and graft occlusion,as well as the comorbid sequelae that complicate interventions in diabetic patients.When opting for PCI,the use of DES and potent platelet inhibitors should be favoured.And when opting for CABG,reduction in perioperative stroke,wound infection,and optimization of post-operative medical management will be of benefit to diabetic patients.Glycaemic control is beneficial to both strategies.

Key words: Diabetes mellitus, Coronary artery disease, Percutaneous coronary intervention, Coronary artery bypass grafting, Antiplatelet agents, Clopidogrel, Drug-eluting stents