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Optimal revascularization strategy for diabetic patients with multivessel coronary artery disease: the duel between

Turgay Celik, Atila Iyisoy, U Cagdas Yuksel

    International Journal of Cardiology
    |August 19, 2007
    PubMed

    Insights

    Coronary artery bypass surgery was preferred for diabetic patients with multivessel coronary artery disease. New trials will determine the best revascularization strategy with drug-eluting stents.

    Area of Science:

    • Cardiovascular Medicine
    • Interventional Cardiology
    • Diabetic Complications

    Background:

    • Historical preference for coronary artery bypass surgery (CABG) over percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary artery disease (CAD) was based on trials predating drug-eluting stents.
    • Previous ACC/AHA guidelines recommended CABG for acute coronary syndromes in this population, assuming graft availability.

    Discussion:

    • The advent of drug-eluting stents (DES) may alter the risk-benefit profile of PCI versus CABG in diabetic patients with multivessel CAD.
    • The limitations of older trials (BARI, ARTS I) and meta-analyses necessitate re-evaluation in light of modern interventional techniques.

    Key Insights:

    • Current evidence suggests CABG may be superior for diabetic patients with multivessel CAD when internal mammary artery grafts are feasible.
    • Recommendations from 2002 may not reflect current optimal treatment due to technological advancements in PCI.

    Outlook:

    • Ongoing trials such as FREEDOM, CARDia, and SYNTAX are crucial for establishing the optimal revascularization strategy.
    • Future research will clarify whether PCI with DES can match or surpass CABG outcomes in this high-risk diabetic population.

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