Does diabetes modify antiischaemic therapeutic options in symptomatic coronary patients?

The assessment of results of medical treatment, angioplasty and coronary by pass surgery in diabetic coronary patients is difficult because of the abse nce of distinction in the subgroups of type 1 and 2 diabetes and of stable and unstable angina. With respect to medical therapy, betablockers are practically without delet erious effects and are effective in diabetic populations. The same is true of other antianginal drugs. Conventional coronary angioplasty is associated with poorer results than th e general population in the long-term, partly because of progression of the coronary artery disease and partly because of an increased incidence of re stenosis. The use of stents improves these results, which are similar to th ose of the general population with single Vessel disease or those without p roteinuria. Coronary bypass surgery, despite a certain perioperative morbidity, is asso ciated with an identical survival rate at 5 years as non-diabetics, providi ng the internal mammary artery is grafted. The comparison between these methods is resumed in the ACIP study which opp oses the 3 strategies, in Morris et al's study comparing medical and surgic al approaches and, finally, in the recent BARI trial where patients were ra ndomly allocated to angioplasty or surgery. It would appear that the surgic al strategy gives better results in multivessel disease. However, many rese rves have been voiced because of the small numbers of patients, the high nu mber of excluded patients and the fact that recent progress in angioplasty with widespread use of stenting associated with the prescription of new ant iaggregant drugs was not taken into account.