Revascularization strategies in patients with diabetes: Evolving concepts

disease in patients with diabetes, while more than 75% of all hospitalizations for diabetic complications are attributable to cardiovascular disease.i,* The risk of death from cardiovascular causes is 3 times greater for patients with diabetes than for patients without diabetes, even with adjustment for age and other known cardiac risk factors, including hypercholesterolemia, hypertension, and tobacco use.’ It is well known that patients with diabetes are at higher risk for myocardial infarction; when myocardial infarction occurs in patients with diabetes, it is associated with a 2-fold increase in acute short-term death and higher rates of reinfarction and long-term death.4w5 Because of this tendency, patients with diabetes account for up to 20% of patients undergoing coronary revascularization procedures. During the past decade, clinical trials and large cohort analyses have attempted to define optimal treatment strategies for patients with coronary artery disease. Whether these treatments need to be individualized for particular subsets of patients, such as patients with diabetes, is controversial. The influence of diabetes mellitus on outcome after revascularization procedures has received considerable attention recently. Understanding these issues is important to the nuclear imaging community, which often plays an important role in evaluating patients and identifying those suitable for revascularization. Coronary artery bypass grafting (CABG), introduced in 1968, has resulted in improved survival and quality of life compared with medical treatment in selected subsets of patients with multivessel coronary artery disease.6~* Diabetes, however, appears to have an unfavorable impact on outcome after surgical revascular