ROSLI Mohd Ali

1
PCI in Diabetic Patients
ROSLI Mohd Ali Head Department of
Cardiology National Heart Institute Kuala Lumpur
2

• 55 year old lady
• Diabetes mellitus Type 2 for 5 yrs
• Overweight 26.7 kg/m2
• Presented with epigastric discomfort 30 Oct
  2006
• Treated for gastritis

BP on admission - 109/57 ECG on admission ST
depression in inferior leads
3
ECG 2nd Nov. 2006
4
Stress test positive with angina and ST
depression (31st Oct 2006) Coronary angiogram
(1st Nov 2006) LAD severe proximal
stenosis LCx - small vessel RCA occluded
proximally with retrograde filling from left
coronary system
5
Investigations FBS 12.4 mmol/L (3.5
5.6) HbA1c 8.5 (lt6.5) TC 3.83
mol/L (lt5.2) HDL-C 0.82 (gt1.15) LDL-C 1.81
(lt3.9) TG 2.62
(lt2.3) Creatinine kinase 55 u/L (lt167) CK-MB
17 u/L (lt25) Normal renal function 2D echo
Hypokinesia in inferobasal mid inferior wall
LVEF 53
6
Referred on the 19th Nov 2006 PCI to RCA LAD
on 21st Nov 2006
Post aspiration predilatation to prox. RCA
7
(No Transcript)
8
Pre PCI
Post PCI
Driver 4.0 x 30 (upsized with 4.5 mm balloon at
18 Atm)
Driver 3.0 x 30 (upsized with 3.5 mm balloon at
18 Atm)
TIMI 3 TMP 3 flows
9
Pre PCI
Post PCI
Cypher 2.75 x 33 (Direct stenting) Upsized with
3.5 mm balloom
10
Discharged well 23rd Nov 2006 Aspirin 150 mg
om Clopidogrel 75 mg om Atenolol 25 mg
om Pravastatin 20 mg pm Metformin 500 mg bd Sc
Mixtard 24 u bd
11
Readmitted on 20th Feb 2007 at 1 pm (3 months
post PCI) Angina for 3 days (AC II) ECG no
new changes Troponin T 0.19 ng/ml (lt0.1)
RBS 11.2 mmol/L (lt11) FBS 7.0 mmol/L (3.5
5.6) HbA1c 7.3
2D echo LVEF 51
12
Treated as for ACS dual antiplatelet agent
sc LMWH iv nitrates Coronary angiogram 510
pm (4 hrs after admission)
13
Cypher in LAD 2.75 x 33 upsized with 3.5 mm
balloon
14
Driver 4.0 x 30 mm (upsized with 4.5 mm
balloon) Driver 3.0 x 30 mm (upsized with 4.0
mm balloon)
IVUS lots of tissue proliferation stents were
well deployed
15
Predilated 2 Cypher 3.5 x 33 mm at 24 Atm
16
Pre PCI
Post PCI
2 Cypher 3.5 x 33 mm at 24 Atm
17
No new elevation in cardiac biomarkers Discharge
well on 23rd Feb 2007 (3 days after PCI)
Pravastatin 20 mg pm Metformin 500 mg bd
sc Mixtard 24 u bd Atenolol 25 mg bd
Aspirin 150 mg om Clopidogrel 75 mg om No
changes to medication Re-emphasis on diabetic
control, diet and exercise
18
Last seen on 16th May 2007 No angina FBS 6.3
mmol/L HbA1c 6.7 LDL-C 1.8 mmol/L HDL-C 1.0
mml/L
Plan Dual antiplatelet for 1 year Restudy
at 9 months Ensure good control of diabetes,
dyslipidaemia
19
Diabetes Mellitus
More diffuse disease, long lesions, smaller
vessel diameter Has higher risk of
restenosis even when vessel diameter is
large Tight control of diabetes Need to control
all the risk factors associated with
diabetes Benefits of drug-eluting stents
Insufficient data comparing DES with BMS in
larger vessel diameter long lesion (outside
protocol)
20
(No Transcript)