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Is coronary artery bypass grafting the treatment of choice for diabetic patients with multivessel disease? Yes

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6961 (Published 13 December 2010) Cite this as: BMJ 2010;341:c6961
  1. Nicholas Brooks, consultant cardiologist 1
  1. 1Wythenshawe Hospital, Manchester M23 9LT, UK
  1. Nicholas.Brooks{at}uhsm.nhs.uk

Nicholas Brooks argues that CABG provides more permanent relief for diabetic patients but Iqbal Malik (doi:10.1136/bmj.c6975) thinks that the evidence is less clear cut

In patients with angina for whom both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are technically feasible, overall mortality and rates of myocardial infarction are similar, but PCI is associated with a higher risk of recurrent myocardial ischaemia. The trade-off between the increased need for re-intervention after PCI and the avoidance of major surgery is generally acceptable. However, diabetes is associated with a particularly high rate of recurrence after PCI and, for patients with multivessel disease, CABG provides more durable symptom relief and a lower risk of late complications.

The evidence

Diabetes is accompanied by a tendency to aggressive atherosclerosis, and the results of myocardial revascularisation are less favourable in diabetic patients than in those without diabetes.1 2 This makes recurrence more likely with PCI because it treats only the obstructions present at the time of the procedure whereas CABG bypasses the entire arterial segment in which the disease is most prevalent, protecting against ischaemia from lesion progression. Moreover, diabetes increases the risks of restenosis and stent thrombosis.3 …

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