Percutaneous Coronary Intervention in Comorbid Patients with Diabetes Mellitus, Chronic Kidney Disease, and Liver Cirrhosis: Clinical Aspects, Strategy, and Recommendations
Keywords:
Keywords: PCI, diabetes mellitus, chronic kidney disease, liver cirrhosis, antithrombotic therapy, contrast-induced nephropathy, multidisciplinary approach.Abstract
Abstract
The combination of diabetes mellitus (DM), chronic kidney disease (CKD), and liver cirrhosis creates a high-risk setting for percutaneous coronary intervention (PCI). This article summarizes current literature and clinical experience, outlining preoperative assessment, interventional strategy, antithrombotic management, measures to reduce contrast-induced nephropathy (CIN), and post-procedural care algorithms. Practical recommendations are provided to support a multidisciplinary approach and decision-making within the Heart Team.
References
1. Bangalore S., et al. Revascularization in patients with diabetes mellitus and multivessel coronary artery disease. J Am Coll Cardiol. 2015.
2. Garcia-Tsao G., et al. Management of the complications of cirrhosis. Hepatology. 2017.
3. Levine GN., et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy. Circulation. 2016.
4. Bangalore S., et al. Revascularization strategies in patients with diabetes and multivessel disease — recent reviews (2019–2022).
5. Mehran R., et al. Contrast-induced nephropathy — prevention and management updates (2019–2021).
6. KDIGO 2012 guideline
7. Garcia‑Tsao G., et al. Management of complications of cirrhosis — reviews 2018–2022.
8. ESC Guidelines on myocardial revascularization — 2018 & 2021 updates.
9. 2020–2022 reviews on antiplatelet therapy duration in high-bleeding-risk patients (DAPT de‑escalation studies).
10. Studies on PCI outcomes in CKD and dialysis patients 2018–2023.
11. Recent data on antiplatelet choice in cirrhosis and thrombocytopenia (2019–2024).
12. Papers on IVUS/FFR use to minimize contrast and optimize PCI (2018–2022).
13. Recent consensus and Heart Team papers on revascularization decision-making (2019–2024).
