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Coronary artery revascularization in patients with diabetes mellitus and multivessel coronary artery disease

Author
Richard W Nesto, MD
Section Editors
Donald Cutlip, MD
David M Nathan, MD
Arie Pieter Kappetein, MD, PhD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Coronary heart disease (CHD) is a major cause of morbidity and mortality among patients with diabetes mellitus. Compared to nondiabetic patients, patients with diabetes are more likely to have CHD, which is most often multivessel, and to have episodes of silent ischemia. As a result of these and other factors, diabetic patients with CHD have a lower long-term survival rate than nondiabetic patients with CHD. (See "Prevalence of and risk factors for coronary heart disease in diabetes mellitus".)

Patients with diabetes comprise as many as 25 to 30 percent of those who undergo revascularization. Outcome data from large registries and subgroup analyses of randomized trials of patients undergoing revascularization are available to guide management decision making. (See 'Outcomes after PCI' below and 'Outcomes after CABG' below.)

The medical and revascularization management of CHD, including the indications for revascularization, are generally similar in patients with and without diabetes. However, the short- and long-term results of revascularization with percutaneous coronary intervention or coronary artery bypass graft surgery are often worse in diabetic patients [1]. (See 'Outcomes compared to patients without diabetes' below.)

This topic will focus on the approach to revascularization in patients with diabetes and multivessel coronary artery disease. The approach to revascularization in diabetic patients with left main or lesser degrees of coronary disease is similar to the broad population of patients and is discussed in other topics. (See "Management of left main coronary artery disease" and "Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention".)

Issues related to medical versus interventional therapy for stable angina in nondiabetic patients and to silent ischemia are discussed separately. (See "Stable ischemic heart disease: Indications for revascularization" and "Silent myocardial ischemia: Prognosis and therapy".)

                             

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Literature review current through: Nov 2016. | This topic last updated: Tue Jan 19 00:00:00 GMT 2016.
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