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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;11\\\/6\\\/33-b\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;11\\\/6\\\/33-b\u0022}],\u0022ac\u0022:{\u0022spmdc;11\\\/6\\\/33-b\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;11\\\/6\\\/33-b\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\n      \u003Ch2\u003ESummary\u003C\/h2\u003E\n      \u003Cp id=\u0022p-1\u0022\u003EDiabetes is an independent predictor of many serious adverse events, including major adverse cardiac events. This article reviews several studies that evaluated revascularization in diabetic patients who have stable coronary artery disease.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n      \u003Cp id=\u0022p-2\u0022\u003EDiabetes is an independent predictor of many serious adverse events, including major adverse cardiac events (MACE). Spencer King, MD, St. Joseph\u0027s Heart and Vascular Institute and Emory University, Atlanta, Georgia, USA, reviewed several studies that evaluated revascularization in diabetic patients who have stable coronary artery disease (CAD). Dr. King discussed the issues that surround the choice of revascularization approach and whether it is needed at all for this group of patients.\u003C\/p\u003E\n      \u003Cp id=\u0022p-3\u0022\u003EThe consensus from the studies that he reviewed indicates that interventional revascularization is gaining parity with surgery for those diabetic patients who fall into a high-risk group, but for stable patients without high-risk CAD and ischemia, revascularization can be deferred. Intensive medical interventions, as described in consensus guidelines [Smith SC Jr. \u003Cem\u003ECirculation\u003C\/em\u003E 2006], are recommended for all diabetic patients with CAD.\u003C\/p\u003E\n      \u003Cp id=\u0022p-4\u0022\u003EThe Emory Angioplasty versus Surgery Trial (EAST), which compared coronary angioplasty (percutaneous transluminal coronary angioplasty; PTCA) with coronary bypass surgery (coronary artery bypass graft; CABG) for patients with multivessel CAD, was the first study to suggest slightly (but not significantly) better survival outcomes for diabetic patients who received CABG compared with those who received angioplasty [King SB III et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2000]. This trend was confirmed in the Bypass Angioplasty Revascularization Investigation (BARI I) trial, in which the survival rate for diabetic patients who received CABG was significantly (p=0.001) improved when compared with those who received PTCA [King SB III et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1994]. This difference was not apparent when comparing similar procedures in nondiabetic patients.\u003C\/p\u003E\n      \u003Cp id=\u0022p-5\u0022\u003EThe SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) trial, which assessed the optimal revascularization strategy for patients with previously untreated three-vessel or left main CAD, reported no difference between the treatment approaches in medically treated diabetic patients with regard to all-cause death\/cerebrovascular events\/myocardial infarction (MI) at 12 months. However, a follow-up subgroup analysis suggested that at 1 year, the MACE and cerebrovascular event rates were higher in the angioplasty group, driven by an increase in repeat revascularization and MACE in patients with high SYNTAX scores [Banning AP et al. \u003Cem\u003EJ AM Coll Cardiol\u003C\/em\u003E 2010].\u003C\/p\u003E\n      \u003Cp id=\u0022p-6\u0022\u003EOne year results from the Coronary Artery Revascularization in Diabetes (CARDIA) trial showed no apparent difference between CABG and PCI in terms of the composite endpoints of death, nonfatal MI, and non-fatal stroke; however, repeat revascularization was higher in the PCI group, which was expected [Kapur A. ESC 2008].\u003C\/p\u003E\n      \u003Cp id=\u0022p-7\u0022\u003EThe question of which treatment approach is best, remains unanswered. The Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease (FREEDOM; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00086450\u0026amp;atom=%2Fspmdc%2F11%2F6%2F33.2.atom\u0022\u003ENCT00086450\u003C\/a\u003E) Trial is an ongoing study that is designed to provide the definitive answer to which treatment approach is best. This trial enrolled 1901 patients with diabetes and multivessel CAD who were eligible for PCI or CABG. Results are anticipated in 2012.\u003C\/p\u003E\n      \u003Cp id=\u0022p-8\u0022\u003EBut is revascularization needed in all diabetic patients with CAD? The BARDI 2D trial compared prompt revascularization with delayed or no revascularization for patients with type 2 diabetes, CAD, and ischemia and no prior CABG or PCI within the past 12 months. The choice of PCI or CABG was selected, based on clinical or angiographic factors. Among high-risk patients (based on angiographic severity) who were selected for CABG, prompt revascularization reduced major cardiovascular (CV) events compared with delayed or no revascularization (p=0.01). Among lower-risk patients who were selected for PCI, the rates of major CV events were similar for the three options.\u003C\/p\u003E\n      \u003Cp id=\u0022p-9\u0022\u003ECV morbidity is a major burden in patients with type 2 diabetes. A target-driven, long-term, intensified intervention that is aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of CV and microvascular events by about 50% [Gaede P et al. \u003Cem\u003ENew Engl J Med\u003C\/em\u003E 2003].\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/6\/33.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn0uq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}