**7. Revascularization for patients with diabetes mellitus and multivessel CAD**

In the BARI 2D trial, the selected revascularization strategy, CABG or PCI, was based on physician discretion, declared independent of randomization to either immediate or deferred revascularization if clinically warranted. They analyzed factors favoring selection of CABG versus PCI in 1,593 diabetic patients with multivessel CAD enrolled between 2001 and 2005. The majority of diabetic patients with multivessel disease were selected for PCI rather than CABG. Preference for CABG over PCI was largely based on angiographic features related to the extent, location, and nature of CAD, as well as geographic, demographic, and clinical factors. [21]

However, with each intervention the benefit is less and the risks and complications are greater than in patients without diabetes. Revascularization for treatment of ST elevation myocardial infarction increases survival. Both interventions relieve symptoms, but neither improves survival except in patients at high risk. In patients with clinically stable chronic coronary disease, survival after CABG or PCI is comparable with that in patients treated with optimal medical therapy alone. Accordingly, evaluation for revascularization can be deferred until signs and symptoms worsen except in patients at high risk. In patients at high risk survival after promptly implemented CABG is greater than that with optimal medical therapy, especially when the diabetes is being treated with insulin sensitizing agents. [22]
