Choice of initial medical therapy vs. prompt coronary revascularization in patients with type 2 diabetes and stable ischemic coronary disease with special emphasis on the BARI 2D trial results

Abstract

In many patients with type 2 diabetes and stable CAD in whom angina symptoms are controlled, OMT alone should be the first-line strategy. In patients with more extensive coronary disease, prompt CABG, in the absence of contraindications, OMT, and an insulin sensitization strategy are a preferred therapeutic strategy to reduce the incidence of myocardial infarction.

Antagonist molecules in the treatment of angina

“…One of the most effective treatments for reducing symptoms of angina is revascularization [14]. Several randomized trials, however, have demonstrated that revascularization does not improve the mortality in patients with stable chronic angina [15–19]. In a recently published meta-analysis of 10 prospective randomized controlled trials with a total of 6752 patients, no differences between percutaneous coronary intervention (PCI) versus medical therapy for all-cause mortality, cardiovascular mortality, angina relief at the end of follow-up were noted.…”

“…PCI was not associated with reductions in all-cause or cardiovascular mortality, myocardial infarction (MI), or angina relief [20]. Surgical revascularization was in fact superior to percutaneous revascularization (BARI2D and FREEDOM) in reducing the death and MI in patients with diabetes [17–19, 21] and those with severe left main, proximal LAD disease or high syntax score (SYNTAX) [22]. These findings continue to support existing clinical practice guidelines that medical therapy be considered the most appropriate initial clinical management for patients with stable angina.…”