Renal and retinal effects of enalapril and losartan in type 1 diabetes.

The Editorialists Reply: Garratt and Bailey suggest that our statement that CABG surgery is the preferred approach to revascularization in patients with diabetes and stable coronary disease was not factual. We respectfully disagree. We clearly emphasized that among such patients who remained symptomatic despite intensive treatment or who had substantial ischemia or extensive coronary artery disease, revascularization with either PCI or CABG was reasonable and appropriate. We explicitly acknowledged that the BARI 2D design precluded any direct comparison between PCI and CABG with regard to clinical outcomes. However, we reasoned that the option of either PCI or CABG for revascularization, depending on the anatomical complexity of coronary disease, is a realworld strength of the trial. In addition, the significant reduction in the composite end point (death, myocardial infarction, or stroke) in patients with diabetes who underwent CABG would inevitably invite indirect comparisons between PCI and CABG among physicians faced with the clinical decision of which choice of revascularization is best suited for a given patient, particularly if the goal of revascularization is to reduce long-term clinical events (especially myocardial infarction). Our recommendation that CABG surgery is the preferred approach to revascularization in patients with diabetes and stable coronary disease is further supported by two other randomized trials1,2 and a recent metaanalysis.3