Revascularization in high risk patients: diabetes mellitus.

Coronary artery disease is the main cause of morbidity and mortality in patients affected by diabetes mellitus. Pathophysiology of atherosclerosis in diabetics exhibit specific characteristics that confer them a high risk. In this regard, revascularization in diabetic patients remains a challenge. Both techniques [percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG)] demonstrate poorer outcomes in diabetics as compared to non diabetic patients. When one revascularization modality has been compared against the other, CABG has consistently demonstrated to be more efficacious than PCI. Thus, current guidelines recommend CABG for the treatment of multivessel disease in diabetics. However, the efficacy of recent developments in the PCI field (i.e. drug-eluting stent) is currently under investigation. The aim of this review is to update current evidence in the field of coronary revascularization in diabetics. Evolution of PCI over time will be specifically addressed as well as current evidence of drug-eluting stents in terms of efficacy and safety in diabetics. Besides, main CABG vs PCI trials will be reviewed. Additionally, we will focus on potential complications to be faced in either revascularization modality. Finally, revascularization in specific subgroup of diabetic patients such as those presenting with acute coronary syndromes or those with diabetes-related systemic complications will also be addressed.