EDITORIAL

Is surgery still the preferred option for coronary revascularisation in diabetics with multivessel coronary disease?

A Kapur¹, I S Malik²

¹ Department of Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, Hammersmith Hospital, London, UK
² Waller Department of Cardiology, St Mary's Hospital, London, UK

Correspondence to:
Correspondence to:
Dr Akhil Kapur, Department of Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, Hammersmith Hospital, DuCane Road, London W12 0HS, UK;
a.kapur@ic.ac.uk

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In patients with diabetes, the choice of optimal revascularisation strategy—bypass surgery or percutaneous coronary intervention—remains controversial

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Keywords: diabetes; coronary artery bypass graft; percutaneous coronary intervention; revascularisation

Abbreviations: ARTS, arterial revascularisation therapies study; BARI, bypass angioplasty revascularisation investigation; BENESTENT, Belgium-Netherlands stent study; CABG, coronary artery bypass graft; CABRI, coronary artery bypass revascularisation investigation; CARDia, coronary artery revascularisation in diabetes; EAST, Emory angioplasty versus surgery trial; EPIC, evaluation of IIb/IIIa platelet receptor antagonist 7E3 in preventing ischemic complications; EPILOG, evaluation of PTCA to improve long-term outcome by c7E3GP IIb/IIIa receptor blockade; EPISTENT, evaluation of platelet GP IIb/IIIa inhibitor for stenting; ERACI, Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease; GABI, German angioplasty bypass investigation; GP, glycoprotein; PCI, percutaneous coronary intervention; RITA, randomised intervention treatment of angina; SOS, stent or surgery; STRESS, stent restenosis study

In the UK 2.5 million people have diabetes. Three quarters of all deaths in patients with diabetes are caused by coronary artery disease. It has been projected that 25–30% of all revascularisations will be in patients with diabetes by 2010. The choice of optimal revascularisation strategy—coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI)—remains controversial.

CABG is considered preferable in diabetic patients with multivessel coronary artery disease based primarily on post hoc analysis of the BARI study. While some other studies have also performed subgroup analyses in patients with diabetes, in none was that analysis prespecified. In light of recent developments in the field of revascularisation, with the advent of glycoprotein (GP) IIb/IIIa inhibitors, use of stents, and the development of off bypass and minimally invasive surgery, the data available to guide treatment in patients with diabetes are in need of reassessment.

Several trials have compared an initial . . . [Full text of this article]

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This article has been cited by other articles:

• Williams, I. L, Vazir, A., Zaman, A. G (2003). Review: The management of stable angina in diabetes. British Journal of Diabetes & Vascular Disease 3: 18-25 [Abstract]