Role of CABG in the management of obstructive coronary arterial disease in patients with diabetes mellitus

Multiple studies have shown that diabetes mellitus (DM) can affect the efficacy of revascularization therapies and subsequent clinical outcomes. Selection of the appropriate myocardial revascularization strategy is critically important in the setting of multivessel coronary disease. Optimal medical therapy is an appropriate first-line strategy in patients with DM and mild symptoms. When medical therapy does not adequately control symptoms, revascularization with either PCI or CABG may be used. In patients with treated DM, moderate to severe symptoms and complex multivessel coronary disease, coronary artery bypass graft surgery provides better survival, fewer recurrent infarctions and greater freedom from re-intervention. Decisions regarding revascularization in patients with DM must take into account multiple factors and as such require a multidisciplinary team approach ('heart team').

► Selection of the optimal myocardial revascularization strategy is critically important in patients with diabetes. ► Optimal medical therapy is an appropriate initial strategy in patients with diabetes, mild symptoms and moderate coronary artery disease. ► Bypass surgery is superior to percutaneous intervention in treated diabetes and multivessel coronary disease. ► Bilateral internal thoracic artery grafting improves outcome but increases sternal wound complications. ► Strict perioperative glycemic control is associated with increased risk off hypoglycemia and is not associated with improved outcomes.