The continued importance of optimal medical therapy with or without revascularization in diabetic patients with coronary artery disease

• Published in: Trends in cardiovascular medicine Vol. 25; no. 7; pp. 632 - 634
• Main Authors: Sidhu, Mandeep S., MD, MBA, FACC, Boden, William E., MD, FACC, FAHA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015; Elsevier Limited
• Subjects: Angioplasty; Balloon treatment; Blood pressure; Cardiovascular; Cardiovascular disease; Cholesterol; Cigarette smoking; Clinical decision making; Clinical outcomes; Clinical trials; Coronary artery; Coronary Artery Bypass; Coronary Artery Disease - therapy; Coronary vessels; Decision making; Diabetes; Diabetes mellitus; Diabetic Angiopathies - therapy; Drug addiction; Heart diseases; Hemoglobin; Humans; Implants; Ischemia; Low density lipoprotein; Mortality; Myocardial infarction; Patients; Percutaneous Coronary Intervention; Population; Smoking cessation; Stents; Surgery; Vascular diseases; Vein & artery diseases
• ISSN: 1050-1738; 1873-2615
• DOI: 10.1016/j.tcm.2015.04.002

While many recent comparative effectiveness trials have attempted to address which form of myocardial revascularization [i.e., percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery] is associated with improved clinical outcomes, more recently there has been a growing recognition that OMT plays a pivotal role in improving hard clinical outcomes such as mortality or myocardial infarction (MI), particularly in light of the fact that SIHD patients with T2DM have diffuse vascular disease that is as much systemic as focal. [16] evaluated the proportion of patients achieving guideline-based, protocol-driven treatment targets for systolic blood pressure, low-density lipoprotein cholesterol (LDL-c), smoking cessation, and hemoglobin A1c (HbA1c). In addition to these contemporary RCTs, a recent patient level meta-analysis with pooled data across 10 RCTs (n = 7812) comparing the effectiveness of CABG with PCI, including 6 trials with balloon angioplasty and 5 trials with bare metal stents, showed that mortality was substantially lower in T2DM patients who underwent CABG (HR = 0.70, 95% CI: 0.56–0.87, p = 0.014 for interaction) [17]. ISCHEMIA will include a sizeable proportion of diabetic patients and will better inform our clinical decision-making in the diabetic cohort as well as the overall SIHD population with moderate to severe ischemia. [...]ISCHEMIA better informs our clinical decision-making in the era