A quarter of people who need myocardial revascularisation have diabetes. After coronary artery bypass surgery and percutaneous coronary interventions, these patients have worse outcomes than those without diabetes.1 They have more extensive coronary atherosclerosis, accelerated plaque progression, an increased rate of restenosis after percutaneous coronary intervention, and faster progression of bypass graft disease after bypass surgery.2 Randomised trials have indicated that—especially in terms of repeated revascularisation procedures—coronary artery bypass surgery is more effective than percutaneous coronary intervention with bare metal stents in patients with diabetes, particularly in multivessel coronary disease.1 In the linked meta-analysis (doi: 10.1136/bmj.a1331), Stettler and colleagues compare the effectiveness and safety of sirolimus eluting stents, paclitaxel eluting stents, and bare metal stents in people with and without diabetes.3

Because of local pharmacological inhibition of restenosis, drug eluting stents reduce the need for repeated revascularisation compared with bare metal stents. It was hoped that these stents would be as effective as coronary artery bypass surgery, even in patients with diabetes. However, in the past two years there …