Diabetic patients with coronary artery disease are associated with an unfavourable long-term outcome. Surgical revascularisation on top of medical therapy has been shown to confer survival benefit in patients with mutivessel and left main disease. With the emergence of the percutaneous approach of revascularisation, several clinical trials have been conducted to compare these two modalities of treatment. Consistent results were demonstrated in the diabetic subgroup that coronary artery bypass grafting is superior to balloon angioplasty in preventing late adverse cardiac event. With the advancement of percutaneous technique using coronary stenting as the predominant mode of catheter based revascularisation, the latest comparison trial showed that stenting is a comparable alternative but is associated with a higher incidence of repeat revascularisation than bypass surgery. However, the debate is not yet settled because of the promising results of platelet glycoprotein IIb/IIIa antagonists and drug-eluting stents in improving the safety and efficacy of percutaneous intervention. It remains to be proven by ongoing clinical trials the best revascularisation strategy for diabetics with multivessel coronary disease.
Wai-Hong Chen, Chu-Pak Lau, Percutaneous Revascularisation in Diabetic Patients with Coronary Artery Disease Journal of the Hong Kong College of Cardiology 2002;10(3) https://doi.org/10.55503/2790-6744.1193
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