You are here

Article Text

Article menu
Download PDFPDF
Editorial
Is surgery still the preferred option for coronary revascularisation in diabetics with multivessel coronary disease?
  1. A Kapur1,
  2. I S Malik2
  1. 1Department of Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, Hammersmith Hospital, London, UK
  2. 2Waller Department of Cardiology, St Mary's Hospital, London, UK
  1. 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{at}ic.ac.uk

https://doi.org/10.1136/heart.87.5.407

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

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

    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.

    CABG VERSUS PCI: THE MAJOR TRIALS

    Several trials have compared an initial treatment strategy of PCI with a strategy of CABG in patients with multivessel coronary disease.1–6 Most of the data currently available relate to comparisons made in the late 1980s and early '90s although several new studies have been published recently. While not identical, each trial randomised patients who were considered suitable for both forms of revascularisation. Results have suggested that there is no difference between the two strategies in terms of mortality, non-fatal MI, and stroke although the rates of additional revascularisation were much higher in the PCI groups.7 PCI usually requires a short admission followed by an early return to work, but is associated with a 30% risk of further revascularisation during the first six months of follow up. Conversely, CABG is more invasive and requires a longer recovery.

    IS THE PATIENT WITH DIABETES MELLITUS DIFFERENT?

    It …

    View Full Text