S ubstantial clinical trial data have accumulated comparing coronary artery bypass grafting (CABG) to percutaneous intervention (PCI) (1–4). These data consistently demonstrate the superiority of CABG over PCI in reducing long-term mortality and myocardial infarction (MI) in patients with stable but aggressive multivessel coronary artery disease (CAD). Aggressiveness of disease can be judged by extent/complexity (SYNTAX [Synergy Between PCI With Taxus and Cardiac Surgery] score) (1,2) or the presence of diabetes (3). CABG results in better outcomes than PCI in these patients, whether PCI is performed by balloon angioplasty alone, with bare-metal stents, or with drug-eluting stents. Diabetes patients included in previous trials have primarily evaluated those with type 2 diabetes (T2DM). In this issue of the Journal, Nyström et al. (5) offers data specifically supporting CABG as the appropriate revascularization modality in patients with type 1 diabetes (T1DM). Why is CABG the consistent “winner” in aggressive multivessel CAD regardless of the PCI procedure? Do we just need better stent platforms, or is there a fundamental difference in the physiological mechanism of benefit between these 2 revascularization procedures that favors CABG over PCI?

中文翻译：

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1 型糖尿病、冠心病的复杂性和最佳血运重建策略 ∗

已经积累了大量临床试验数据，将冠状动脉旁路移植术 (CABG) 与经皮介入术 (PCI) 进行了比较 (1-4)。这些数据一致证明 CABG 在降低稳定性但具有侵袭性的多支血管冠状动脉疾病 (CAD) 患者的长期死亡率和心肌梗死 (MI) 方面优于 PCI。可以通过程度/复杂性（SYNTAX [PCI 与紫杉和心脏手术之间的协同作用] 评分）(1,2) 或糖尿病的存在 (3) 来判断疾病的侵袭性。无论是单独通过球囊血管成形术、使用裸金属支架还是使用药物洗脱支架进行 PCI，CABG 在这些患者中的结果都优于 PCI。先前试验中纳入的糖尿病患者主要评估了 2 型糖尿病 (T2DM) 患者。在本期杂志中，Nyström 等人。(5) 提供的数据特别支持 CABG 作为 1 型糖尿病 (T1DM) 患者的适当血运重建方式。为什么不管 PCI 程序如何，CABG 始终是侵袭性多支血管 CAD 的“赢家”？我们是否只需要更好的支架平台，或者这两种有利于 CABG 而非 PCI 的血运重建手术之间的生理获益机制是否存在根本差异？