The role of coronary artery bypass surgery versus percutaneous intervention in patients with diabetes and coronary artery disease |
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| Affiliation: | 1. Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Canada;2. Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil;3. Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;4. ICES, Toronto, Canada;5. Munk Chair in Advanced Cardiac Therapeutics, Peter Munk Cardiac Centre and Toronto General Research Institute, Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Canada;1. Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK;2. Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy;3. Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK;1. Department of Epidemiology, Mailman School of Public Health, Columbia University, United States of America;2. Department of Medicine, College of Physicians and Surgeons, Columbia University, United States of America;3. Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, United States of America;1. Department of Endocrinology, Diabetes and Nutrition, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France;2. Department of Vascular Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France;3. Department of Biostatistics, Hospices Civil de Lyon, Lyon, France;4. Université Lyon I, Villeurbanne, France;5. CNRS, UMR 5558, Laboratoire Biostatistiques Sante, Pierre-Bénite, France;6. Inserm U1060, Faculté de Médecine Lyon sud, Oullins, France |
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| Abstract: | Patients with diabetes mellitus (DM) often exhibit a complex coronary anatomy, making coronary revascularization challenging. Coronary artery bypass grafting surgery (CABG) is currently considered the preferred revascularization method in patients with DM and multivessel disease. Percutaneous coronary intervention (PCI) has advanced with new stent generations having been developed in the recent years, but they have not yet been adequately compared against CABG in the population with DM. Comorbidities, such as renal disease and heart failure, lead to worse prognosis following a revascularization procedure and require especial consideration when choosing between CABG versus PCI. The presence of significant left main disease may also impose additional challenges to coronary revascularization, particularly when accompanied by the involvement of multivessel disease. Most of the evidence regarding revascularization in patients with DM is compiled from studies enrolling patients with stable ischemic heart disease, and trials with patients in the acute coronary syndrome setting are lacking. |
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