title: Revascularization for Advanced Coronary Artery Disease in Type 2 Diabetic Patients: Choosing Wisely Between PCI and Surgery.
abstract: Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of systemic atherosclerosis and advanced coronary artery disease (CAD). Herein, we review clinical trials comparing surgical to percutaneous revascularization in the context of the unique pathophysiology in this patient population, and seek to answer the question of optimal strategy of revascularization.
  
  
  
  Early studies showed a signal towards benefit of surgical revascularization over percutaneous revascularization in this group, but there was a paucity of randomized clinical trials (RCT) to directly support this finding. The Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM), a large-scale international RCT, was then undertaken and established the benefit of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in terms of mortality, myocardial infarction and repeat revascularization; CABG was inferior to PCI with regards to stroke. The quality of life and cost effectiveness also demonstrated a long-term benefit for surgery. The decision as to choice of mode of revascularization in patients with T2DM and advanced CAD depends upon a multitude of factors, including the coronary anatomy, co-morbidities and the patient's surgical risk. These factors influence the recommendation of the cardiovascular team, which should result in a balanced presentation of the short and long-term risks and benefits of either mode of revascularization to the patient and his/her family.
authors.affiliation: Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, NY, 10016, USA. Louai.Razzouk@nyumc.org.
authors.forename: Louai
authors.initials: L
authors.lastname: Razzouk
authors.affiliation: Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, NY, 10016, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
authors.affiliation: Peter Munk Cardiac Centre, Toronto, Ontario, Canada.|Heart and Stroke Richard Lewar Centre of Excellence in CV Research, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D001026:Coronary Artery Bypass; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Advanced coronary artery disease; CABG; Diabetes; PCI