Coronary heart disease in patients with diabetes: part II: recent advances in coronary revascularization

Although diabetic patients represent approximately one-quarter of all those undergoing revascularization, their outcomes after revascularization are usually worse compared with non-diabetic patients. We examined the recent advances in percutaneous and surgical revascularization that are relevant to the treatment of diabetic patients. A systematic review of publications in the past 5 years (2000 to 2005) relating to coronary revascularization in diabetes was undertaken. Early and mid-term follow-up of diabetic patients after revascularization indicates that the incidence of myocardial infarction and repeat revascularization are reduced in surgically treated patients compared with those treated by balloon angioplasty alone. Percutaneous coronary intervention (PCI) with bare metal stents has reduced the surgical advantage (for reintervention) in the early-mid-term; however, repeat revascularization in diabetic patients continues to be substantially higher after PCI. Advances in PCI include the use of drug-eluting stents and adjunctive drug therapies, such as abciximab. Glycemic control is an important determinant of outcome after revascularization in diabetic patients, and the impact of tight glycemic control after PCI is currently being investigated in the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 in Diabetes). Improvements in PCI and coronary artery bypass graft surgery are leading to better results in diabetic patients, and clinical trials are presently comparing contemporary PCI with surgery.