Weighing Coronary Revascularization Options in Patients with Diabetes Mellitus

Publication date: Available online 19 August 2019Source: Canadian Journal of DiabetesAuthor(s): Lucas C. Godoy, Caio A.M. Tavares, Michael E. FarkouhAbstractPatients with diabetes (DM) are at increased risk for developing coronary artery disease (CAD). Choosing the optimal revascularization strategy, i.e. coronary artery bypass grafting – CABG – 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, CABG 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 (two or single vessel disease, especially without involvement of the proximal left anterior descendent artery), PCI may be a viable option. Since 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 under-represented 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. Absence from smoking, control of cholesterol, blood pressure and glycemic levels, regular practice of physical activit...
Source: Canadian Journal of Diabetes - Category: Endocrinology Source Type: research