title: Medical Treatment and Revascularization Options in Patients With Type 2 Diabetes and Coronary Disease.
abstract: There are scant outcomes data in patients with type 2 diabetes and stable coronary artery disease (CAD) stratified by detailed angiographic burden of CAD or left ventricular ejection fraction (LVEF).
  
  
  
  This study determined the effect of optimal medical therapy (OMT), with or without percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), on long-term outcomes with respect to LVEF and number of diseased vessels, including proximal left anterior descending artery involvement.
  
  
  
  A patient-level pooled analysis was undertaken in 3 federally-funded trials. The primary endpoint was the composite of death, myocardial infarction (MI), or stroke, adjusted for trial and randomization strategy.
  
  
  
  Among 5,034 subjects, 15% had LVEF <50%, 77% had multivessel CAD, and 28% had proximal left anterior descending artery involvement. During a median 4.5-year follow-up, CABG + OMT was superior to PCI + OMT for the primary endpoint (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.59 to 0.85; p = 0.0002), death (HR: 0.76; 95% CI: 0.60 to 0.96; p = 0.024), and MI (HR: 0.50; 95% CI: 0.38 to 0.67; p = 0.0001), but not stroke (HR: 1.54; 95% CI: 0.96 to 2.48; p = 0.074). CABG + OMT was also superior to OMT alone for prevention of the primary endpoint (HR: 0.79; 95% CI: 0.64 to 0.97; p = 0.022) and MI (HR: 0.55; 95% CI: 0.41 to 0.74; p = 0.0001), and was superior to PCI + OMT for the primary endpoint in patients with 3-vessel CAD (HR: 0.72; 95% CI: 0.58 to 0.89; p = 0.002) and normal LVEF (HR: 0.71; 95% CI: 0.58 to 0.87; p = 0.0012). There were no significant differences in OMT versus PCI + OMT.
  
  
  
  CABG + OMT reduced the primary endpoint during long-term follow-up in patients with type 2 diabetes and stable CAD, supporting this as the preferred management strategy.
authors: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca.
authors: G B John
authors: GB
authors: Mancini
authors: Department of Medicine, Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada.
authors: Michael E
authors: ME
authors: Farkouh
authors: Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors: Maria M
authors: MM
authors: Brooks
authors: St. Louis University School of Medicine, St. Louis, Missouri.
authors: Bernard R
authors: BR
authors: Chaitman
authors: Department of Medicine, Albany Medical College, Albany, New York.
authors: William E
authors: WE
authors: Boden
authors: Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors: Helen
authors: H
authors: Vlachos
authors: West Haven Veterans Administration Coordinating Center, West Haven, Connecticut.
authors: Pamela M
authors: PM
authors: Hartigan
authors: New England Research Institutes, Incorporated, Watertown, Massachusetts.
authors: Flora S
authors: FS
authors: Siami
authors: Department of Medicine, Albany Medical College, Albany, New York.
authors: Mandeep S
authors: MS
authors: Sidhu
authors: University of Alabama at Birmingham, Birmingham, Alabama.
authors: Vera
authors: V
authors: Bittner
authors: Mayo Clinic, Rochester, Minnesota.
authors: Robert
authors: R
authors: Frye
authors: Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Valentin
authors: V
authors: Fuster
mesh_terms: D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery bypass grafting; optimal medical therapy; percutaneous coronary intervention; stable ischemic heart disease