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Updated: Jan 6, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus
Lucas C Godoy1, Caio A M Tavares2, Michael E Farkouh3
1Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto, Toronto, Ontario, Canada; Instituto do Coracao, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Insights
Patients with diabetes mellitus and coronary artery disease often benefit from coronary artery bypass grafting over percutaneous coronary intervention for stable multivessel disease. Lifestyle changes are crucial post-revascularization for managing cardiovascular disease risk factors.
Area of Science:
- Cardiology
- Diabetology
- Vascular Medicine
Background:
- Patients with diabetes mellitus (DM) have a higher risk of coronary artery disease (CAD).
- Optimal revascularization strategy selection (coronary artery bypass grafting vs. percutaneous coronary intervention) is challenging in this population.
- Evidence suggests coronary artery bypass grafting is generally superior to percutaneous coronary intervention for stable multivessel disease in patients with DM.
Purpose of the Study:
- To review current literature on managing patients with DM and CAD undergoing revascularization.
- To discuss the comparative effectiveness of different revascularization strategies in diabetic patients.
- To highlight the importance of risk factor management post-revascularization.
Main Methods:
- Literature review of current evidence.
- Analysis of studies comparing coronary artery bypass grafting and percutaneous coronary intervention in diabetic patients with CAD.
- Synthesis of findings regarding revascularization outcomes and post-procedure management.
Main Results:
- Coronary artery bypass grafting is typically superior to percutaneous coronary intervention for stable multivessel ischemic heart disease in patients with DM, showing lower long-term mortality, myocardial infarction, and repeat revascularization rates.
- Percutaneous coronary intervention may be a viable option for less complex coronary anatomy (e.g., single- or two-vessel disease without proximal left anterior descending artery involvement).
- Evidence is limited for patients with DM and left main disease or those presenting with acute coronary syndromes.
Conclusions:
- Coronary artery bypass grafting is generally preferred for stable multivessel CAD in diabetic patients.
- Percutaneous coronary intervention can be considered for select cases with less complex disease.
- Aggressive risk factor control (smoking cessation, lipid, blood pressure, glycemic management, diet, exercise) is essential after revascularization to prevent cardiovascular disease progression.
Abstract:
Patients with diabetes mellitus (DM) are at increased risk for developing coronary artery disease. Choosing the optimal revascularization strategy, such as coronary artery bypass grafting or percutaneous coronary intervention (PCI), may be difficult in this population. A large body of evidence suggests that, for patients with DM and stable multivessel ischemic heart disease, coronary artery bypass grafting is usually superior to PCI, leading to lower rates of all-cause mortality, myocardial infarction and repeat revascularization in the long term. In patients with less complex coronary anatomy (2- or single-vessel disease, especially without involvement of the proximal left anterior descendent artery), PCI may be a viable option. Because these anatomic patterns are less frequent in patients with DM, there is less evidence to guide revascularization in these cases. Patients with DM and left main disease and those in the acute coronary syndrome setting are also underrepresented in randomized trials, and the best revascularization strategy for these patients is not clear. Once the revascularization procedure is performed, patients should be kept engaged in controlling the risk factors for progression of cardiovascular disease. Avoidance of smoking, control of cholesterol, blood pressure and glycemic levels; regular practice of physical activity of at least moderate intensity; and a balanced diet are of key importance in the post-revascularization period. In this study, we review the current literature in the management of patients with DM and coronary artery disease undergoing a revascularization procedure.
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