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Medical Management of Diabetes and Heart Disease - part 9

Rozenman et al. báo cáo restenosis xảy ra trong 35% nondiabetics, 36% bệnh nhân tiểu đường không phụ thuộc insulin, và trong 61% bệnh nhân tiểu đường yêu cầu của insulin | 238 Douglas more repeat revascularizations and disease progression in nontarget lesions and development of new lesions in sites that were previously normal 22-26 . Rozen-man et al. reported restenosis occurred in 35 of nondiabetics 36 of diabetics who were not insulin dependent and in 61 of insulin-requiring diabetics p 0.04 24 . Barsness et al. who carefully studied paired angiograms baseline and at 5 years in 320 diabetic and nondiabetic patients treated percutaneously in BARI reported more restenosis in diabetics 43 vs. 27 p 0.01 and more new lesions in diabetics 3 vs 2 p 0.002 indicating an accelerated disease process in diabetics compared to nondiabetics 26 . Investigators in CA-BRI attempted to explain poor outcomes after balloon angioplasty in diabetic patients by analyzing the amount of baseline disease and the completeness of revascularization in diabetics compared to nondiabetics they found them to be similar leading these investigators to believe that a greater rate of disease progression in diabetics was the reason that diabetic patients fared poorly 27 . Data from EAST is also consistent with an important role of disease progression. In EAST the survival of diabetic and nondiabetic patients treated with angioplasty was comparable for about 5 years. Subsequently the survival curves diverged significantly with diabetics experiencing a higher late mortality see Fig. 3 28 . This delayed divergence of the survival curves occurred too late to be caused EAST - PTCA PATIENTS Treated diabetes Yes 90 - 80 - CT c I CO 70 - 60 50 - Q 40 - Q CL 30 - 20 - 10 - 0 - 0 1 2 3 4 5 6 7 8 Years after Randomization No. of Patients Ì Percent Surviving No 169 157 929 148 87.6 139 846 118 82.6 Yes 29 27 93 1 26 89.7 20 75.9 13 60 1 Figure 3 Eight-year survival of patients with and without treated diabetes in the Emory Angioplasty Surgery Trial EAST who were randomized to PTCA 28 . Copyright Marcel Dekker Inc. All rights reserved. Marcel Dekker Inc. 270 Madison Avenue New York