Percutaneous coronary intervention versus coronary artery bypass grafting in diabetic patients.
Revascularization with CABG or angioplasty in diabetic patients is associated with a less favor-able outcome. The value of early intervention will be assessed in the ongoing BARI 2D trial. It remains to be determined whether the widespread use of GP IIb/IIIa drugs and prolonged dual antiplatelet therapy in diabetic patients who receive stents, and possibly drug-eluting stents, will alter results significantly so that outcomes become comparable or even better than CABG (Fig. 3). It seems prudent to consider CABG with LIMA grafting in diabetic patients who have severe multi-vessel disease and to consider angioplasty in selected patients who have more discrete and less severe disease.
Mukherjee
Debabrata
D
Division of Cardiovascular Medicine, University of Kentucky, 900 S. Limestone Street, 326 Wethington Building, Lexington, KY 40536-0200, USA. mukherjee@uky.edu
D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D003925:Diabetic Angiopathies / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D006965:Hyperplasia; D007333:Insulin Resistance; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D019233:Retreatment; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017539:Tunica Intima / Q000473:pathology
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine