Coronary artery bypass grafting remains the treatment of choice for diabetics with left main stem disease.
The optimum revascularisation strategy for left main stem (LMS) disease between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) remains controversial. No single trial has compared outcomes following percutaneous coronary intervention (PCI) or surgical coronary artery bypass grafting (CABG) in diabetics with unprotected LMS disease as the primary analysis. However, several randomised controlled trials (RCTs) comparing the two treatments include this comparison in subgroup analyses. 5-year follow up data is available for the NOBLE and EXCEL trial with 10 year data available for the SYNTAX and PRE-COMBAT trials. Of these studies, only SYNTAX was sufficiently powered for mortality as a primary endpoint with the others favouring the composite outcome of Major Adverse Cardiac and Cerebrovascular Events (MACCE), including cardiac death, stroke, and myocardial infarction.
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