Is Coronary Artery Bypass Grafting (CABG) Surgery Still Preferable to Percutaneous Coronary Intervention (PCI) in View of Long-Term Outcomes among Diabetic Patients?

Abstract

Coronary Artery Bypass Grafting (CABG) is the preferred revascularization modality among diabetic patients due to extensive coronary involvement and elevated risk of restenosis. Since drug-eluting stent significantly reduces restenosis, we expect it to narrow down the long-term benefit-gap between these two revascularization strategies. In our review, we compare the long-term outcomes of Percutaneous Coronary Intervention (PCI) to CABG in diabetic patients. While PCI can be a reasonable alternative to CABG at a low SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score, an intermediate-high SYNTAX score makes CABG necessary. In left main stem occlusion, PCI and CABG demonstrated similar long-term outcomes. However, in cases of bifurcation or unprotected left main stem disease, revascularization is best done via CABG. Indeed, CABG is the main revascularization therapy in multivessel involvement— it lowers the risk of all-cause mortality, myocardial infarction and repeat revascularization at the expense of increasessd stroke. Glycaemic control, use of antiplatelet agents and feelings of disability are all factors that can potentially affect long-term outcomes. We expect hybrid coronary revascularization (HCR) involving both robotic surgery and PCI to be the future trend in treating diabetic patients with multivessel disease, although its clinical use needs further studies.