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Diabetes and multivessel disease: coronary artery bypass grafting remains king

Lucas Colombo Godoy1,2, Vivek Rao3, Michael E Farkouh1

  • 1Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada.

Current Opinion in Cardiology
|July 12, 2018
PubMed

Insights

For patients with diabetes mellitus and multivessel coronary artery disease, coronary artery bypass grafting (CABG) demonstrates superior long-term outcomes compared to percutaneous coronary intervention (PCI). CABG reduces mortality in this high-risk population.

Area of Science:

  • Cardiology
  • Diabetology
  • Vascular Surgery

Background:

  • Diabetes mellitus (DM) and multivessel coronary artery disease (MVD) present complex treatment challenges.
  • Choosing between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) has been controversial.

Purpose of the Study:

  • To review current scientific evidence on revascularization strategies for patients with DM and MVD.
  • To inform decision-making regarding the optimal revascularization approach.

Main Methods:

  • Review of recently published scientific evidence.
  • Analysis of observational studies and randomized trials, including the FREEDOM trial.
  • Inclusion of meta-analysis data comparing CABG and PCI.

Main Results:

  • Coronary artery bypass grafting (CABG) shows superiority over percutaneous coronary intervention (PCI) in long-term follow-up for diabetic patients with MVD.
  • CABG is also preferred in diabetic patients with comorbidities like renal failure or heart failure.
  • Recent meta-analysis confirms significantly reduced all-cause mortality with CABG versus PCI in this population.

Conclusions:

  • Coronary artery bypass grafting (CABG) is the recommended revascularization strategy for most patients with diabetes mellitus and multivessel coronary artery disease.
  • Evidence supports CABG over PCI, particularly in patients with specific comorbidities and in acute coronary syndrome settings.
Abstract

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