Several randomized trials have compared hemodialysis strategies in patients with diabetes and have shown better results with coronary artery bypass grafting (cabg) compared to percutaneous coronary intervention (PCI). The researchers sought to find aggressive pharmacological treatments and the use of drug-eluting stents with the aim of altering the hemodialysis pathway in patients with diabetes and multiple lesions in the coronary arteries. A study by Michael E, MD, PhD, of the Cardiovascular Institute in New York, USA, found that in patients with diabetes and advanced coronary artery disease, CABG therapy was superior to PCI therapy in terms of significant reductions in mortality and myocardial infarction rates, but also had a higher incidence of stroke. Their paper was published in the November 4, 2012 online edition of the leading international journal NEJM. In this randomized trial, the investigators randomly assigned patients with diabetes and multiple diseased coronary arteries to receive PCI plus drug-eluting stent therapy or CABG, respectively. Patients were followed for at least 2 years (median time, 3.8 years). All patients received currently recommended medications to control LDL cholesterol, systolic blood pressure, and glycated hemoglobin. The primary endpoint of the trial was a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. The results showed that from 2005 to 2010, researchers enrolled 1,900 patients at 140 international centers. The mean age of the patients was 63.1 ± 9.1 years, 29% were female, and 83% had triple coronary artery lesions. The researchers found that more patients in the PCI group reached the trial’s primary endpoint (P=0.005), with a 5-year attainment rate of 26.6%, compared with 18.7% in the CABG group. The study found that the benefit of CABG was affected by myocardial infarction (P<0.001) and death from any cause (P=0.049). The researchers observed a higher frequency of stroke in the CABG-treated group, with a 5-year incidence of 5.2%, compared with 2.4% in the PCI-treated group (P=0.03). The researchers concluded that CABG treatment was superior to PCI treatment in significantly reducing mortality and myocardial infarction rates in patients with diabetes and advanced coronary artery disease.