Coronary artery bypass grafting in diabetic patients

Diabetes is associated with an increased risk of coronary artery disease (CAD) as a result of multiple thrombotic and inflammatory pathways that are enhanced by hyperglycaemia, dyslipidaemia, obesity, insulin resistance and oxidative stress. In comparison with non-diabetics, in diabetics the risk of adverse events is markedly increased after coronary revascularization.

Randomized trials comparing percutaneous coronary intervention (PCI) with drugeluting stents versus coronary artery bypass grafting (CABG) in patients with diabetes showed superior outcomes with CABG and current clinical guidelines recommend CABG as the preferred revascularization strategy in diabetic patients with complex CAD. There are, however, several uncertainties about how to perform the procedure. [...]