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Coronary revascularization in patients with diabetes mellitus. Macrovascular complications of diabetes mellitus and particularly difuse coronary artery atherosclerosis, confer a high risk of morbidity and mortality to this population. Percutaneous coronary intervention (PCI) is the preferred mode of coronary revasculari- zation in acute coronary syndromes withlwithout ST elevation, due to the availability of this procedure in emergency situations and to the fact that the benefit is similar in patients with or without diabetes. In symptomatic stable coronary artery disease, large clinical trials including BARI-2D and FREEDOM have clarified the respective role of PCI and of Coronary Artery By-Pass Surgery (CABG) in patients with multiple vessel disease. The superiority of CABG over PCI is clearly demonstrated in multivessel disease, particu- larly with a high SYNTAX score related to complex lesions. The optimal surgical approach should use the two internal mammary arteries in order to ensure a complete revascularization and to reduce delayed scar healing and infection. The surgical approach in this context improves mortality, reduces the risk of repeat revascularization and preserves cardiac function. The decision of the type of procedure should be taken as recommended by the Haute Autorité de Santé (HAS) by a heart team including an interventional cardiologist, a cardiac surgeon anda diabetologist, and shouldfollow international recommendations such as those of the European Society of Cardiology (Class 1A).