Role of PCI in Diabetes Continues to Evolve

Issue: May/June 2017

ByDeepak L. Bhatt, MD, MPH

In this issue of Cardiology Today’s Intervention, the Cover Story focuses on PCI and its role in the care of patients with diabetes. This is a large and growing segment of the population in the United States and globally. There has been a great deal of interest in patients with diabetes and CAD, both on the procedural and medical sides. In particular, an ongoing area of controversy has been the optimal care of patients with diabetes and symptomatic multivessel CAD.

Several trials have been performed in the eras of balloon angioplasty, bare-metal stenting, and first- and second-generation drug-eluting stents. The gap in the need for repeat revascularization between cardiac surgery and PCI has been dropping through each of these improvements in PCI. Nevertheless, a gap does remain in favor of CABG vs. PCI for the endpoint of repeat revascularization. However, in general, the literature supports a lower risk of stroke with PCI vs. CABG in the setting of multivessel disease requiring revascularization.

Therefore, in the diabetic patient with multivessel CAD, it is a matter of weighing the risks of surgery, especially stroke, against a need for revascularization that will be higher if PCI is the initial strategy. Making this decision involves assessment of the patients’ other comorbidities, their surgical risk, their left ventricular function and, importantly, their preferences.

In the case of complex multivessel disease with or without diabetes, consultation with the heart team can be quite useful. Thus, the care of the patient with diabetes and complex symptomatic CAD remains a challenging and evolving area. In the Cover Story, a variety of experts provide their valuable perspectives on these and related issues. Let us know your thoughts on this issue by emailing the Editors at intervention@healio.com.

— Deepak L. Bhatt, MD, MPH

Chief Medical Editor

Cardiology Today’s Intervention