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Diabetes and multivessel disease: coronary artery bypass grafting remains king

Godoy, Lucas Colomboa,b; Rao, Vivekc; Farkouh, Michael E.a

doi: 10.1097/HCO.0000000000000550
COMPLEX ISSUES IN CORONARY REVASCULARIZATION: Edited by Subodh Verma and Bobby Yanagawa

Purpose of review Review the recently published scientific evidence to support the decision-making process of revascularization strategy in patients with diabetes mellitus (DM) and multivessel coronary artery disease (MVD).

Recent findings Recently published observational analyses have proven the superiority of coronary artery bypass grafting (CABG) in patients presenting with other comorbidities together with DM, such as renal disease or heart failure.

Summary Significant challenges and controversies surrounded the choice of the appropriate revascularization method in patients with DM and MVD over the last decades. FREEDOM trial was the first adequately powered randomized study to directly compare percutaneous coronary intervention (PCI) versus CABG in the DM population, showing the superiority of CABG in the long-term follow-up. Subsequently, other studies confirmed that CABG is also preferable over PCI in diabetic patients with particular comorbidities, such as renal failure and left ventricular dysfunction, and also in patients with type 1 DM and in the setting of an early acute coronary syndrome. Finally, in 2018, an individual level data meta-analysis reported an expressive reduction in all-cause mortality when comparing CABG versus PCI in patients with DM and MVD enrolled in the most recent clinical trials (hazard ratio 1.44, 95% confidence interval 1.20–1.74, P = 0.0001).

aPeter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada

bInstituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

cMunk Chair in Advanced Cardiac Therapeutics, Peter Munk Cardiac Centre and Toronto General Research Institute, Division of Cardiovascular Surgery, Toronto General Hospital, Canada

Correspondence to Dr Michael E. Farkouh, MD, MSC, Peter Munk Cardiac Centre, 585 University Avenue – 4N474, Toronto, Ontario, Canada M5G 2N2. Tel: +1 416 340 3141; e-mail: michael.farkouh@uhn.ca

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