While older trials favored CABG over PCI for diabetic patients with multivessel disease, newer percutaneous techniques have made the optimal revascularization strategy controversial.
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Optimal revascularization strategy remains controversial for diabetic multivessel disease; leaves open whether modern PCI has closed the gap with CABG.
Diabetes mellitus affects about 6% of the U.S. population and represents a significant public health challenge, with numbers of those affected increasing every year. The most common cause of death in these patients is macrovascular disease, with coronary disease being the predominant form. The pathophysiology of coronary disease in patients with diabetes is complex and involves elements of hyperglycemia, dyslipidemia, hyperinsulinemia, as well as a procoagulant vascular milieu. First-generation trials looking at revascularization of multivessel disease in patients with diabetes have had long clinical follow-up periods and seem to consistently favor coronary bypass grafting over percutaneous interventions; however, newer trials that include the use of stents and glycoprotein IIb/IIIa inhibitor therapy as part of the latter strategy have raised some interesting questions, so that the issue remains controversial and by no means settled.
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Ghosh et al. (2003) studied this question.
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