Revascularization Benefits Include Prolongation Of Life

Coronary artery revascularization with PCI and CABG provides symptomatic palliation superior to that achieved with medical therapy. The degree of ischemia relief and symptomatic benefit obtained by diabetics, however, may be difficult to determine because of a blunted appreciation of ischemia and absence of typical anginal symptoms. The strongest case for benefit from coronary revascularization comes from the randomized trials of CABG and medical therapy, where CABG

was life prolonging in patients with left main coronary artery stenosis, three-

vessel coronary disease with abnormal LV function, and two- or three-vessel disease and >75% stenosis of the left anterior descending coronary artery. A

meta-analysis of three major randomized trials comparing CABG with medical therapy also confirmed a survival benefit was achieved by surgery for patients with one-vessel disease involving the left anterior descending coronary artery

(Table 1) (4). Although these trials did not specifically test outcomes in diabetics, there is reason to believe that diabetics do benefit especially in the more severely diseased subsets. This position is strongly supported by the Bypass Angioplasty

Revascularization Investigation (BARI), which compared CABG with PCI in S

multivessel disease and reported that CABG prolonged life at 5 years in treated diabetics, a benefit that persisted at 7-year follow-up (survival of 84.4% with <j

CABG vs. 80.9% with PCI; p = 0.043) (see Fig. 1) (5). It is important to note, £

however, that this survival benefit was confined to patients receiving an internal mammary artery graft, a strategy that is already firmly in place in most centers.

Table 1 Medical Therapy vs Revascularization with CABG

CABG prolongs life in the following subgroups

Left main coronary stenosis Three-vessel disease with LV dysfunctiona Two- or three-vessel disease and >75% LAD One-vessel disease involving LADb a Benefit increases with increasing left ventricular (LV) dysfunction.

b From meta-analysis by Yusuf et al. (4).

CABG = coronary bypass surgery; LAD = left anterior descending coronary artery.

To restate, coronary bypass surgery has a potential for prolonging life in diabetics with severe coronary disease. Consequently, aggressive screening for this problem is justified in the diabetic population where severe coronary disease is common and underdiagnosed.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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