Diabetes and multivessel disease: coronary artery bypass grafting remains king.

PURPOSE OF REVIEW: Review the recently published scientific evidence to support the decision-making process of revascularization strategy in patients with diabetes mellitus (DM) and multivessel coronary artery disease (MVD).

RECENT FINDINGS: Recently published observational analyses have proven the superiority of coronary artery bypass grafting (CABG) in patients presenting with other comorbidities together with DM, such as renal disease or heart failure.

SUMMARY: Significant challenges and controversies surrounded the choice of the appropriate revascularization method in patients with DM and MVD over the last decades. FREEDOM trial was the first adequately powered randomized study to directly compare percutaneous coronary intervention (PCI) versus CABG in the DM population, showing the superiority of CABG in the long-term follow-up. Subsequently, other studies confirmed that CABG is also preferable over PCI in diabetic patients with particular comorbidities, such as renal failure and left ventricular dysfunction, and also in patients with type 1 DM and in the setting of an early acute coronary syndrome. Finally, in 2018, an individual level data meta-analysis reported an expressive reduction in all-cause mortality when comparing CABG versus PCI in patients with DM and MVD enrolled in the most recent clinical trials (hazard ratio 1.44, 95% confidence interval 1.20-1.74, P = 0.0001).