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CABG may confer improved survival over PCI in patients with diabetes
Among patients with diabetes with CVD in the Coronary Artery Revascularization Evaluation registry, CABG was associated with better long-term survival and reduced risk for major adverse cardiac events compared with PCI.
Using the community-based, multicenter registry, researchers collected data on 3,156 patients undergoing coronary revascularization procedures from February to July 2004 who also had follow-up data by 2011. Of those, 1,082 patients had diabetes (334 underwent CABG, 748 underwent PCI with drug-eluting stents or bare-metal stents). The patients with diabetes were matched with 240 patients from each treatment group.
“Unlike a lot of other studies that focus on select groups of patients who receive special therapies, our results reflect a ‘real world’ picture of contemporary medical practice and are broadly applicable to the general population of diabetic patients with severe [CAD],” Paul Kurlansky, MD, from Columbia University Medical Center in New York, said in a press release.
Death was more common among patients who underwent PCI compared with CABG (OR = 0.6; 95% CI, 0.39-0.93). In addition, the incidence of major adverse cardiac events, including mortality, nonfatal MI or revascularization, were higher with PCI vs. CABG (OR = 0.57; 95% CI, 0.31-0.7). A significant improvement in Kaplan-Meier event-free survival also was observed with CABG vs. PCI (P = .001).
Kurlansky said CABG may be more effective in this growing segment of the population because diabetes is a systemic disease, rather than a localized disease. “Since PCI addresses localized lesions, CABG addresses the entire downstream circulation, which tends to be a more complete solution for these patients,” he said.
In an accompanying editorial published in the Annals of Thoracic Surgery, Robert F. Tranbaugh, MD, from the division of cardiac surgery at Mount Sinai Beth Israel, commended the researchers for their “efforts to better define the optimal treatment of diabetic patients with [CAD]. … It is important for these findings to be incorporated into the management of diabetic patients with multivessel heart disease, starting with an emphasis on the heart team approach. Cardiac surgeons and cardiologists need to work together in the decision making and need to be advocates for our patients, seeking the safest and more durable treatment option,” Tranbaugh wrote. – by Jennifer Byrne
Disclosure: Kurlansky and Tranbaugh report no relevant financial disclosures.