Challenges of Acute Coronary Syndrome in Diabetic Patients: How to Improve Cardiovascular Outcome

Outcomes of patients with acute coronary syndrome (ACS) and myocardial infarction have dramatically improved over recent decades as a result of implementing novel infrastructures (coronary care units with continuous ECG monitoring), devices (external defibrillator), drugs (thrombolytic agents), and treatment strategies (invasive treatment). During the long course of this unquestionable success story, diabetic patients always demonstrated a worse outcome compared with their nondiabetic counterparts. The reasons for the increased risk include co-morbidities like renal impairment or heart failure. Of particular interest in this setting are the pro-inflammatory and pro-thrombotic states as well as the increased platelet reactivity in diabetics potentially necessitating a more aggressive anti-platelet regimen in such high-risk patients. Adherence to guidelines improves the prognosis of patients with ACS. In the case of diabetic patients, an early invasive treatment strategy as well as the use of glycoprotein (GP) IIb/IIIa inhibitors (GPIs) is associated with an improved outcome; but, these treatments are underutilized in the real world. However, that the effect of GPIs might be far less pronounced in patients receiving a fast-acting and potent oral anti-platelet drug.