What is the role of fibrinolysis?

Abnormally slow fibrinolysis is a recently established independent risk factor for coronary artery disease. In individuals with non-insulin-dependent diabetes mellitus, there is an increase in plasma-activating inhibitor-1 activity (PAI-1 activity). This has been associated with insulin resistance, and there is a direct correlation between hyperinsulinemia and an increase in PAI-1 activity.

Is it true that in diabetic patients, the atherosclerotic disease is more diffuse and seldom operable?

No. It has long been assumed that diffuse coronary atherosclerosis is associated with diabetes mellitus, implying that these patients have an inoperable disease. Recent data have failed to show any true incidence of more diffuse coronary artery disease in diabetic individuals compared with non-diabetics. This observation is important when considering revascularization by coronary artery bypass graft. The vessels do appear to be similarly operable in both groups.

Is there a difference in success rate for coronary artery bypass grafting in diabetic versus nondiabetic patients?

No. Although diabetics have a higher risk of perioperative groin and sternal wound infections, as well as renal insufficiency, the late follow-up after surgery shows a similar survival and symptom-free interval for diabetics compared to nondiabetics. One study suggested a slower flow

rate in the grafts of individuals with diabetes, but this has not been confirmed in subsequent studies. Overall, the two groups behave similarly.

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