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Revascularization Strategies in Patients with Diabetes and Acute Coronary Syndromes

Thiago L Scudeler1, Lucas C Godoy1,2, Tedi Hoxha2,3

  • 1Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Current Cardiology Reports
|January 28, 2022
PubMed

Insights

Coronary revascularization in patients with diabetes mellitus (DM) and acute coronary syndrome (ACS) shows CABG may be superior to PCI for multivessel disease, especially in NSTE-ACS. Primary PCI is preferred for STEMI.

Area of Science:

  • Cardiology
  • Diabetology
  • Interventional Cardiology

Background:

  • Diabetes Mellitus (DM) significantly increases cardiovascular risk.
  • Acute Coronary Syndrome (ACS) management in diabetic patients requires careful consideration of revascularization strategies.
  • Optimal treatment strategies for DM patients with ACS remain an area of active research.

Purpose of the Study:

  • To review current evidence on coronary revascularization in patients with DM experiencing ACS.
  • To compare outcomes of Coronary Artery Bypass Graft surgery (CABG) versus Percutaneous Coronary Intervention (PCI) in this population.
  • To identify optimal revascularization strategies based on ACS type and disease extent.

Main Methods:

  • Review of current evidence and existing literature.
  • Analysis of observational data and sub-analyses of randomized studies.
  • Focus on outcomes such as mortality, myocardial infarction, and repeat revascularization.

Main Results:

  • Coronary Artery Bypass Graft surgery (CABG) shows superiority over Percutaneous Coronary Intervention (PCI) in stable multivessel disease, reducing mortality and repeat procedures.
  • Primary PCI is the recommended revascularization method for ST-segment-elevation myocardial infarction (STEMI) when feasible.
  • For non-ST-segment-elevation ACS (NSTE-ACS) with multivessel disease, CABG may be preferred in diabetic patients, supported by observational data.
  • Limited randomized controlled trials (RCTs) exist for revascularization strategies in DM patients with ACS.

Conclusions:

  • CABG may offer improved long-term outcomes compared to PCI in diabetic patients with multivessel coronary disease, particularly in the NSTE-ACS setting.
  • While primary PCI is standard for STEMI, further research is needed to clarify optimal strategies for residual lesions.
  • Evidence suggests CABG is a viable and potentially superior revascularization strategy for specific subgroups of diabetic patients with ACS.
Abstract

Keywords:
Acute coronary syndromeCoronary artery bypass graftingDiabetes mellitusMyocardial infarctionPercutaneous coronary intervention

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