Stable Angina and Revascularization in Type 1 Diabetic Patient

Coronary artery disease (CAD) is a major cause of death and disability worldwide, with stable angina being an important and common presentation of this disease. The risk increases with age, family history of early CAD, diabetes, and smoking. Therefore, its presentation in a young patient is not that usual, resulting in a clinical challenge as it refers to its management. We report a case of a 38-year-old woman with long-standing type 1 diabetes mellitus associated with nephropathy stage IV, hypertension, and hypothyroidism, who developed symptoms of stable angina. She was submitted to a thorough evaluation with cardiac stress test and scintigraphy with pharmacological stress that showed signs of myocardial ischemia. Then, a cardiac catheterization showed injuries that demonstrated the need of cardiac intervention. It was determined that the percutaneous intervention in association with medical therapy was the optimal treatment for the patient. At the end of the chapter, a series of questions will provide the reader a better understanding of the rationale that goes behind the diagnosis and the interpretation of the tests indicated in this case. All is based on pretest likelihood probability, guidelines, and recommendations that guide the evaluation and the clinical decision in the management of the patient with stable coronary artery disease.