Author/Editor		Brecelj, Aleš
Title		Posebnosti kirurškega zdravljenja koronarne bolezni pri bolnikih s sladkorno boleznijo
Translated title		Surgical treatment of coronary artery disease in diabetic patients
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 40, št. Suppl 3
Publication year		2001
Volume		str. 105-9
Language		slo
Abstract		Diabetes mellitus promotes the development of coronary artery disease and heart failure. Coronary artery disease is a late complication of diabetes mellitus, reflecting involvment of the micro- and macrocirculation. Cardiovascular manifestations of diabetes mellitus include accelerated atherosclerosis, atypical ischaemic pain, silent myocardial infarction and autonomic neuropathy. Diabetes mellitus as an independent risk factor increasis morbidity and mortality following coronary artery bypass surgery by 16.7%. Compared to other patients undergoing surgery, diabetic subjects show a more diffuse involvment of their coronary vessels and therefore require more endarterectomies. The indications for myocardial revascularisation in diabetic patients are the same as in nondiabetic subjects. Coronary bypass surgery is considered in patients who do not benefit from drug treatment and do not meet the criteria for percutaneus transluminal coronary angioplasty and intracoronary stent implantation. The indications for surgical revascularisation are: three-vessel disease, main artery stenosis, two-vessel disease involving the proximal segment of the left anterior coronary artery, and two-vessel disease with poor left ventricular function. The management of coronary artery disease in diabetic patients could be improved by earlier detection and better understanding of the pathophysiological processes underlying the effect of diabetes mellitus on coronary artery disease development and treatment. This could be achieved by improving the accuracy of non-invasive diagnostic procedures. The main effort, however, should be aimed at preventing the development of coronary artery disease.
Summary		Sladkorna bolezen je odgovorna za pospešen nastanek koronarne bolezni in srčnega popuščanja. Koronarna bolezen je pozen zaplet sladkorne bolezni in je odraz prizadetosti mikro- in makrocirkulacije. Srčno-žilni odrazi sladkorne bolezni so pospešena ateroskleroza, atipična ishemična bolečina, tihi srčni infarkt in nevropatija avtonomnega živčnega sistema. Sladkorna bolezen kot samostojni dejavnik tveganja pospešuje obolevnost in umrljivost po revaskularizaciji miokarda z obvozi za 16,7 %. Pri sladkornih bolnikih, ki jih operiramo, opažamo difuznejšo prizadetost koronark in zato napravimo več endarteriektomij. Indikacije za revaskularizacijo miokarda so pri bolnikih s sladkorno boleznijo enake kot pri bolnikih brez nje. Gre za bolnike, ki jim zdravljenje z zdravili ne pomaga in niso primerni za katetersko razširitev koronarnih žil in vložitev endoluminalne proteze (stent). Ti bolniki imajo trožilno koronarno bolezen, zožitev debla leve koronarne arterije, dvožilno koronarno bolezen, ki vključuje začetni del leve sprednje venčne arterije, dvožilno bolezen srca in oslabelo funkcijo levega prekata. Zdravljenje sladkornih bolnikov s koronarno boleznijo bi lahko še izboljšali z zgodnjim odkrivanjem bolezni in boljšim poznavanjem patofizioloških procesov vplivanja sladkorne bolezni na nastanek zapletov in njihovo zdravljenje. To bi dosegli z večjo natančnostjo neinvazivnih diagnostičnih postopkov. Glavna usmeritev pa bi morala biti preprečevanje koronarne bolezni.
Descriptors		DIABETES MELLITUS CORONARY DISEASE CORONARY ARTERY BYPASS