The Impact of Different Treatment Strategies on Cardiac Death and MI Rates in Patients with Type 2 Diabetes and Stable Coronary Disease, N Engl J Med2009; 360:2503- 2515.
In patients with type 2 diabetes and stable ischemic heart disease … prompt revascularization significantly reduced major cardiovascular events, as compared with intensive medical therapy, among patients who were selected to undergo CABG but not among those who were selected to undergo PCI.
… patients who have diabetes, evidence of myocardial ischemia, and extensive multivessel disease would benefit from prompt surgical revascularization mainly because of a lower rate of nonfatal myocardial infarction.
… for the many patients with type 2 diabetes who have less extensive coronary disease and for whom PCI is judged to be more appropriate, prompt revascularization did not reduce the risk of cardiovascular events, as compared with medical therapy.
Among patients for whom CABG was deemed to be the appropriate treatment, prompt revascularization reduced the rate of major cardiovascular events, as compared with medical therapy, particularly among patients who were assigned to receive insulin sensitization. In the PCI stratum, however, revascularization did not reduce the rate of death or major cardiovascular events when added to medical therapy.