<International Circulation>:ccording to a subgroup analysis from the multinational SYNTAX study recently published in JACC， for patients with diabetes and complex multivessel coronary artery disease， the risk of repeat vascularization within one year is elevated 3-fold after percutaneous coronary intervention (PCI) compared to surgery. Can you comment on this conclusion?

Donald E. Cutlip ：I don’t think this is surprising.  Diabetes is a major risk factor for restenosis for both bare metal and drug-eluting stents.  In these high risk patients with multivessel disease these risks are even higher.  The real question is whether these risks translate to differences in mortality or myocardial infarction and possibly whether the risks might be stratified by lesion complexity (Syntax score) as was observed for the overall SYNTAX population.