Current concepts on coronary revascularization in diabetic patients

Area of Science:

• Cardiology
• Diabetology
• Vascular Surgery

Background:

• Diabetic mellitus (DM) patients with coronary artery disease (CAD) exhibit a significantly elevated risk of adverse cardiovascular events compared to non-diabetic individuals.
• Effective management hinges on aggressive cardiovascular prevention and stringent blood glucose control.

Purpose of the Study:

• To outline optimal coronary revascularization strategies for patients with diabetes mellitus and coronary artery disease.
• To guide clinical decision-making regarding invasive versus conservative management and surgical versus percutaneous interventions.

Main Methods:

• Review of current evidence and guidelines for revascularization in diabetic patients with CAD.
• Emphasis on individualized treatment based on coronary angiography findings, ischaemic burden, ventricular function, and comorbidities.
• Discussion of the role of heart teams in complex cases.

Main Results:

• A conservative strategy may be suitable for stable patients with moderate CAD and preserved left ventricular function.
• An early invasive approach is favored for patients experiencing acute coronary syndromes (ACS).
• Coronary artery bypass surgery (CABG) threshold is generally lower in DM patients; drug-eluting stents (DES) and potent antiplatelet agents are recommended for percutaneous coronary intervention (PCI).

Conclusions:

• Revascularization strategies for DM patients with CAD must be tailored to individual risk profiles and disease severity.
• Advancements in antiplatelet therapies, stent technology (e.g., second-generation DES, bioresorbable stents), and surgical techniques promise improved outcomes.
• Multidisciplinary heart team collaboration is crucial for optimizing management and prognosis in this high-risk population.