Details

Autor(en) / Beteiligte

• Sidhu, Mandeep S., MD, MBA, FACC
• Boden, William E., MD, FACC, FAHA

Titel

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

Ist Teil von

• Trends in cardiovascular medicine, 2015-10, Vol.25 (7), p.632-634

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• 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