ARTS Study Conclusion although surgery carries a significant risk of cerebrovascular accident. Diabetic patients showed poor clinical outcome in the stent group when compared to the CABG group. Consequently, surgery may be preferable to stenting in patients with multivessel coronary disease and diabetes, although surgery carries a significant risk of cerebrovascular accident.
SOS Trial 3.9 3.49 Hazard Ratio P=0.001 Hazard Ratio P=0.007 For Stent vs. Surgery to have a repeat revascularization For Stent vs. Surgery for 3 year mortality
Results of Randomized Trials in Diabetics Diabetics Increased early and late adverse events after both PTCA/CABG Both approaches-suboptimal But CABG superior to PTCA ↑ restenosis ↓ complete revascularization ↑ disease progression Therapy directed to lesion vs. vessel
PTCA or CABG for Multivessel Disease ; Considerations Need for revascularization Need for complete revascularization LV function Technical/anatomic factors Individual patient circumstances
Revascularization in Patients with Multivessel Disease CABGPCI Triple vessel disease LV dysfunction LMCA disease Diffuse disease Double vessel disease ※ Preserved LV function ※ Suitable anatomy ※ Advanced age “Salvage”procedure Diabetics? ※ Majority of pt in randomized trials