Amartya Kundu1, Partha Sardar2, Kevin O'Day3, Saurav Chatterjee4, Theophilus Owan5, J Dawn Abbott6. 1. Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA. 2. Division of Cardiovascular Medicine, University of Utah Health Science Center, 30 North 1900 East, Room 4A100 SOM, Salt Lake City, UT, 84132, USA. parthasardarmd@gmail.com. 3. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA. 4. Department of Cardiology, Saint Francis Hospital, Teaching Affiliate, University of Connecticut School of Medicine, Hartford, CT, USA. 5. Division of Cardiovascular Medicine, University of Utah Health Science Center, 30 North 1900 East, Room 4A100 SOM, Salt Lake City, UT, 84132, USA. 6. Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, RI, USA.
Abstract
PURPOSE OF REVIEW: This review describes the dynamic relationship between diabetes mellitus (DM) and coronary artery disease (CAD) with respect to different revascularization strategies and how angiographic tools such as the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score can supplement clinical decision-making. RECENT FINDINGS: The SYNTAX score characterizes the anatomical extent of CAD in terms of the number of lesions, functional importance, and complexity. Studies not limited to patients with DM suggest that percutaneous coronary intervention (PCI) is a reasonable alternative to coronary artery bypass grafting (CABG) in patients with low-medium SYNTAX scores, while patients with high SYNTAX scores should be revascularized with CABG if operable. Similar findings were also observed for diabetes patients with multivessel disease in retrospective pooled analysis. The SYNTAX II score combines anatomical and clinical risk to improve upon the decision regarding the optimal revascularization strategy. The SYNTAX II score can be applied to patients with DM. The SYNTAX scores provide guidance to clinicians faced with determining the optimal revascularization strategy in patients with DM and advanced CAD. Using a heart team approach, the information can be considered along with other factors that influence PCI or CABG risk.
PURPOSE OF REVIEW: This review describes the dynamic relationship between diabetes mellitus (DM) and coronary artery disease (CAD) with respect to different revascularization strategies and how angiographic tools such as the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score can supplement clinical decision-making. RECENT FINDINGS: The SYNTAX score characterizes the anatomical extent of CAD in terms of the number of lesions, functional importance, and complexity. Studies not limited to patients with DM suggest that percutaneous coronary intervention (PCI) is a reasonable alternative to coronary artery bypass grafting (CABG) in patients with low-medium SYNTAX scores, while patients with high SYNTAX scores should be revascularized with CABG if operable. Similar findings were also observed for diabetespatients with multivessel disease in retrospective pooled analysis. The SYNTAX II score combines anatomical and clinical risk to improve upon the decision regarding the optimal revascularization strategy. The SYNTAX II score can be applied to patients with DM. The SYNTAX scores provide guidance to clinicians faced with determining the optimal revascularization strategy in patients with DM and advanced CAD. Using a heart team approach, the information can be considered along with other factors that influence PCI or CABG risk.
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