title: Surgical Revascularization versus Percutaneous Coronary Intervention and Optimal Medical Therapy in Diabetic Patients with Multi-Vessel Coronary Artery Disease.
abstract: Coronary artery disease (CAD) is the leading cause of death in patients with diabetes mellitus (DM). Patients with DM and CAD undergoing revascularization with either a surgical or a percutaneous approach are at higher risk of adverse outcomes and mortality compared with non-DM patients. It is within this background that the optimal choice of revascularization is of critical importance in this high-risk population. The large FREEDOM trial randomized 1900 patients with DM and multivessel CAD to either revascularization with coronary artery by-pass graft (CABG) surgery or percutaneous coronary intervention (PCI). Compared with PCI, CABG significantly reduced the rates of death and myocardial infarction but was associated with a higher risk of stroke. In a real-world setting the decision-making process for the optimal revascularization strategy in these patients is challenging as many clinical factors may influence the decision to either pursue a surgical or a percutaneous revascularization. However, the current consensus is that CABG should be the preferred revascularization strategy in diabetic patients with extensive multivessel CAD.
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Giustino
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York. Electronic address: George.Dangas@mountsinai.org.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
mesh_terms: D002317:Cardiovascular Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: CABG; Coronary artery disease; Diabetes mellitus; PCI; Revascularization