title: Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement?
abstract: Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds.
authors.affiliation: Head Cardiac Unit, Otamendi Hospital, Buenos Aires School of Medicine. Electronic address: arodriguez@centroceci.com.ar.
authors.forename: Alfredo E
authors.initials: AE
authors.lastname: Rodriguez
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D003920:Diabetes Mellitus / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods; D016896:Treatment Outcome
keywords: Coronary artery bypass surgery; Diabetes; Drug eluting stent; Multiple vessel disease