Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

Due to the extensive nature of coronary involvement and elevated risk of restenosis, Coronary Artery Bypass Grafting (CABG) has been regarded as the mainstay of revascularization modality in diabetic patients. Nonetheless, since the introduction of drug-eluting stent, the rate of restenosis has declined significantly. Given this substantial improvement, the long-term-benefit-gap between these two revascularization strategies could have been narrowed. Our study is conducted to review and compare the long-term outcomes of PTCA with CABG in diabetic patients. The long-term treatment effects of revascularization strategies depend on the complexity and nature of the coronary vessels involved. At a low SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score, PTCA can be a reasonable alternative to CABG but an intermediate-high SYNTAX score will herald the need for CABG. In left main stem occlusion, PTCA and CABG demonstrated similar long-term outcomes. However, when the disease is accompanied by bifurcation or is classified as unprotected left main stem disease, revascularization strategy favours CABG. Meanwhile in multivessel involvement, CABG confers a lower risk of all-cause mortality, myocardial infarction, repeat revascularization at the expense of increased stroke, suggesting that CABG is the main revascularization therapy in this patient population. Factors such as glycaemic control, feelings of being disabled and use of antiplatelet agents can potentially affect the long-term outcomes. In the future, hybrid coronary revascularization that involves both robotic surgery and PTCA might be a new trend in treating multivessel disease in diabetic patients but its clinical use needs further studies.