- Question
- Do aggressive medical therapy and drug-eluting stents change the best revascularization strategy for patients with diabetes and multivessel coronary artery disease: PCI or coronary artery bypass grafting (CABG)?
- Design
- Randomized, open-label (no masking) trial enrolling 1900 patients from 2005 through 2010 at 140 international centers. Minimum follow-up was 2 years (median among survivors 3.8 years).
- Population
- Patients with diabetes and multivessel coronary artery disease; mean age 63.1 years, 29% women, and 83% with three-vessel disease.
- Intervention
- Percutaneous coronary intervention (PCI) with drug-eluting stents, together with currently recommended medical therapy to control LDL cholesterol, systolic blood pressure, and glycated hemoglobin.
- Control
- Coronary artery bypass grafting (CABG) with the same recommended medical therapy for control of LDL cholesterol, blood pressure, and glycated hemoglobin.
- Primary outcome
- Composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke.
- Results
- The primary outcome occurred more often with PCI (P=0.005), with 5-year rates of 26.6% in the PCI group versus 18.7% in the CABG group. The benefit of CABG was driven by lower rates of myocardial infarction (P<0.001) and death from any cause (P=0.049).
- Safety
- Stroke was more frequent with CABG, with 5-year rates of 2.4% in the PCI group and 5.2% in the CABG group (P=0.03).
- Conclusion
- In patients with diabetes and advanced coronary artery disease, CABG was superior to PCI because it significantly reduced death and myocardial infarction, at the cost of a higher stroke rate.
- Why it matters
- The trial established bypass surgery as the preferred revascularization strategy for diabetic patients with multivessel disease, even in the era of drug-eluting stents and modern medical therapy, while highlighting the need to weigh the higher stroke risk when deciding.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026