title: Revascularization Strategies in Patients with Diabetes Mellitus and Acute Coronary Syndrome.
abstract: Patients with diabetes mellitus (DM) have more severe CAD and higher mortality in acute coronary syndrome (ACS) than patients without DM. The optimal mode of revascularization-coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)-remains controversial in this setting. For patients with DM and ST-segment elevation myocardial infarction, prompt revascularization of the culprit artery via PCI is generally preferable. In non-ST-elevation ACS, the decision on mode of revascularization is more challenging. Trials comparing CABG with percutaneous transluminal coronary angioplasty, bare metal stents, and first-generation drug-eluting stents in DM patients with multivessel have demonstrated decreased mortality in those receiving CABG. On the other hand, trials and retrospective analyses comparing CABG to PCI with second-generation drug-eluting stents have not shown a statistically significant mortality benefit favoring CABG. This potentially narrowed that gap between CABG and PCI requires further investigation.
authors.affiliation: Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System and New York University School of Medicine, 227 E 30th St, Office 835, New York, NY, 10016, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Buntaine
authors.affiliation: Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System and New York University School of Medicine, 227 E 30th St, Office 835, New York, NY, 10016, USA. binita.shah@nyumc.org.
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
authors.affiliation: Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System and New York University School of Medicine, 227 E 30th St, Office 835, New York, NY, 10016, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Lorin
authors.affiliation: Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System and New York University School of Medicine, 227 E 30th St, Office 835, New York, NY, 10016, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D048909:Diabetes Complications / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Coronary artery bypass grafting; Diabetes mellitus; Myocardial infarction; Percutaneous coronary intervention