Coronary revascularization strategies in patients with multivessel disease: is it all about diabetes?
Coronary artery disease (CAD) is the worldwide leading cause of mortality, with increasingly prevalent manifestations due to population aging and growth (1). From an anatomic standpoint, CAD varies from atherosclerosis of a single major epicardial vessel to more advanced presentations with multiple vessels simultaneously involved. Numerous clinical trials have appraised the comparative efficacy and safety of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multivessel CAD revascularization (2). In particular, SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) randomized patients with left main and/or three-vessel CAD (3), whereas BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) randomized patients with two- or three-vessel CAD (and was prematurely interrupted due to slow enrollment) (4). Both studies reported increased rates of combined ischemic events in multivessel CAD patients treated by PCI, driven by higher rates of repeat revascularization (3,4).