Multivessel revascularization in diabetes

In the US approximately 700,000 patients undergo multivessel coronary revascularization yearly, and 25% of these patients have diabetes.

The Bypass Angioplasty Revascularization Investigation (BARI) trial, patients with diabetes and multivessel disease who underwent coronary bypass grafting lived longer than patients undergoing balloon angioplasty.: Leading to the recommendation for CABG”6as the preferred approach for revascularization in such patients.

PCI intervention and accompanying medical therapy studies have consistently shown a trend towards more frequent major adverse cardiovascular and cerebrovascular events in patients with diabetes and multiple coronary artery disease who underwent PCI than among those who underwent CABGs.

Similarly, in the error of drug eluting stents, trials have shown increased rate of major adverse cardiovascular and cerebrovascular events atb12 months for patients with multivessel disease with diabetes who underwent PCI with such stents, as compared with coronary bypass grafts (Kapur A et al, Serruys PW et al).

In a randomized trial assigning patients with diabetes and multivessel coronary artery disease to undergo either PCI with drug eluting stents or coronary artery bypass graft: patients were followed for a minimum of two years and were treated with conventional medical therapy: Coronary artery bypass graft was superior to PCI with significant reduced rates of death and myocardial infarction, however with a higher rate of stroke (Farkouh ME at al, FREEDOM Trial).

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