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Chapter 40. Special Patient Subset: Diabetes Mellitus

In comparison with percutaneous coronary intervention (PCI), which of the following best explains the benefit of coronary artery bypass grafting (CABG) in patients with diabetes mellitus and multivessel coronary artery disease (CAD)?

A. Fewer procedural complications with CABG

B. Progression of disease following PCI

C. Superior long-term patency of saphenous vein conduits compared with drug-eluting stents

D. Higher periprocedural mortality with PCI compared with CABG

The correct answer is B

Patients with diabetes mellitus treated with PCI are at increased risk for progression of disease in nontreated segments of the coronary artery, which often leads to recurrent ischemic events and the need for subsequent repeat revascularization.

Compared with bare metal stents, drug-eluting stents reduce the incidence of which of the following in patients with diabetes?

A. Stent thrombosis

B. Periprocedural myocardial infarction

C. Restenosis

D. Periprocedural bleeding complications

The correct answer is C

Bare metal stents were developed to reduce the incidence of restenosis following balloon angioplasty. Neointimal proliferation within the stent became an important limitation, leading to restenosis and need for subsequent revascularization, particularly in diabetic patients. Drug-eluting stents were developed to decrease the incidence neointimal proliferation and restenosis.

CABG surgery is preferred to PCI in which of the following clinical scenarios in patients with diabetes?

A. A 45-year-old man with unstable angina and a 90% stenosis in the mid right coronary artery

B. A 60-year-old woman with rheumatoid arthritis on steroids, unstable angina, and a 70% discrete stenosis in the proximal circumflex artery and 90% ulcerated stenosis in the proximal right coronary artery

C. A 55-year-old man with stable angina and an 80% stenosis in the proximal left anterior descending artery, a 100% stenosis in the proximal right coronary artery, and a 70% stenosis in the proximal left circumflex artery

D. An 80-year-old man with stable class III angina and a 100% chronic occlusion of the proximal right coronary artery

The correct answer is C

The 2011 American College of Cardiology Foundation/American Heart Association guidelines for CABG recommends CABG in preference to PCI to improve survival in patients with multivessel coronary artery disease and diabetes, particularly in patients in whom a left internal mammary arterial ...

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