Domenico Tavella
Interventional Cardiology University Hospital, Italy
Title: Severe obstructive coronary artery disease in a young female patient affected by Diabetes Mellitus type 1 Clinical-angiographic features and review of the literature
Biography
Biography: Domenico Tavella
Abstract
It is well known that Diabetes Mellitus (DM) is the most powerful risk factor for Coronary Artery Disease (CAD). More than half the mortality and a vast amount of morbidity in people with DM is related to CAD. A quarter of myocardial revascularization procedures are performed in patients with DM. There are wide differences in the prevalence of CAD in patients with type 1 or 2 diabetes, being more represented in the second both in terms of incidence and severity of coronary involvement and worse intra/extra-hospital prognosis. 38yo-female, type1-diabetic in insulinic-therapy since the age of 8 years was admitted to our institution for a recurrent chest pain. Poor glycaemic control (fasting glucose 158 mg/dL; HbA1c 9.8%), extensive organ damage (already known peripheral vascular disease 5 years ago, severe hypertensive retinopathy 10 years ago treated by Laser-Therapy with current proliferative evolution, EPH-Gestosis), normal kidney function (Creatinin 1,07 mg/dL; GFR 56 ml/min/1.73m2) was evident. Treadmill Test was negative at 90%. CA-MSCT “unexpectedly” showed severe and extensive multifocal coronary disease on both very small LAD and RCA, confirmed by coronary angiography (CA) with successive PCI/DES on LAD and RCA, starting long ASA/Clopidogrel therapy. 3-months CA showed excellent result on LAD and tight intrastent re-stenosis on RCA with distal disease progression, treated by DEB intrastent and DES on distal. The therapy was shifted from ASA/Clopidrogrel to ASA/Prasugrel. While i’m writing, after 14 months since last procedure, the patient, asymptomatic and cardiac event-free, is admitted for temporal stroke and severe kidney failure bringing to dialysis.