Is ischemia the only factor predicting cardiovascular outcomes in all diabetes mellitus patients?
Is ischemia the only factor predicting cardiovascular outcomes in all diabetes mellitus patients?
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DOI：
10.1186/s12933-017-0533-7
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发表时间：
2017-04-20
影响因子：
9.3
通讯作者：
Kedhi E
中科院分区：
文献类型：
--
作者：
Kennedy MW;Fabris E;Suryapranata H;Kedhi E
糖尿病（DM）与心血管疾病发病率和死亡率的增加有关，其特征是冠状动脉疾病的发病率增加。此外，一旦动脉粥样硬化形成，与非DM患者相比，其程度、复杂性和进展更快。缺血是未来心脏硬事件的唯一最重要的预测因素，缺血校正仍然是当前血运重建策略的基石。然而，最近的数据表明，在糖尿病患者中，冠状动脉粥样硬化，尽管没有缺血，通过侵入性或非侵入性方法检测，可能不与相同的低风险的未来心脏事件在非糖尿病患者中看到的。本综述旨在研究目前支持缺血驱动血运重建策略的证据，并挑战缺血是预测所有糖尿病患者心血管结局的唯一临床相关因素的观点。具体而言，我们研究了糖尿病患者中某些缺血以外的特征，如微血管疾病、冠状动脉粥样硬化负担、进展和斑块组成，是否需要考虑这些高危患者的更精确的风险分层。
Diabetes mellitus (DM) is associated with an excess in cardiovascular morbidity and mortality, and is characterized by increased rates of coronary artery disease. Furthermore, once atherosclerosis is established, this is associated with an increased extent, complexity and a more rapid progression than seen in non-DM patients. Ischemia is the single most important predictor of future hard cardiac events and ischemia correction remains the cornerstone of current revascularization strategies. However recent data suggests that, in DM patients, coronary atherosclerosis despite the absence of ischemia, detected by either invasive or non-invasive methods, may not be associated with the same low risk of future cardiac events as seen in non-DM patients. This review seeks to examine the current evidence supporting an ischemia driven revascularization strategy, and to challenge the notion that ischemia is the only clinically relevant factor in the prediction of cardiovascular outcomes in all-comer DM patients. Specifically, we examine whether in DM patients certain characteristics beyond ischemia, such as microvascular disease, coronary atherosclerosis burden, progression and plaque composition, may need to be considered for a more refined risk stratification in these high-risk patients.