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Revascularization Strategies in Patients with Diabetes Mellitus and Acute Coronary Syndrome

  • Management of Acute Coronary Syndromes (AS Jaffe, Section Editor)
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Abstract

Patients with diabetes mellitus (DM) have more severe CAD and higher mortality in acute coronary syndrome (ACS) than patients without DM. The optimal mode of revascularization—coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)—remains controversial in this setting. For patients with DM and ST-segment elevation myocardial infarction, prompt revascularization of the culprit artery via PCI is generally preferable. In non-ST-elevation ACS, the decision on mode of revascularization is more challenging. Trials comparing CABG with percutaneous transluminal coronary angioplasty, bare metal stents, and first-generation drug-eluting stents in DM patients with multivessel have demonstrated decreased mortality in those receiving CABG. On the other hand, trials and retrospective analyses comparing CABG to PCI with second-generation drug-eluting stents have not shown a statistically significant mortality benefit favoring CABG. This potentially narrowed that gap between CABG and PCI requires further investigation.

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Acknowledgments

Binita Shah is supported in part by the Biomedical Laboratory Research and Development Service of the VA Office of Research and Development (I01BX007080).

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  1. Department of Medicine, Division of Cardiology, VA New York Harbor Healthcare System and New York University School of Medicine, 227 E 30th St, Office 835, New York, NY, 10016, USA

    Adam J. Buntaine, Binita Shah, Jeffrey D. Lorin & Steven P. Sedlis

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This article is part of the Topical Collection on Management of Acute Coronary Syndromes

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Buntaine, A.J., Shah, B., Lorin, J.D. et al. Revascularization Strategies in Patients with Diabetes Mellitus and Acute Coronary Syndrome. Curr Cardiol Rep 18, 79 (2016). https://doi.org/10.1007/s11886-016-0756-3

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