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Angioplasty, bypass surgery options for patients with diabetes, CAD
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PHILADELPHIA — For patients with diabetes and multivessel coronary artery disease, coronary artery bypass grafting shows higher procedural benefit compared with percutaneous coronary intervention, according to a presentation at the Heart in Diabetes Medical Conference.
However, the latest generation of stents may be closing the gap, Michael E. Farkouh, MD, MSc, clinical epidemiologist at Mount Sinai New York and Peter Munk Chair in Multinational Clinical Trials at the Peter Munk Cardiac Center in Toronto, said.
“What do you do when patients [with diabetes] have multivessel disease, ST-elevation MI?” Farkouh said in his presentation. “How do you do stenting of the primary problem and then go back and do bypass before you do angioplasty? These are the questions of the future.”
In recent years, debate has escalated on the preferred treatment for patients with diabetes and CAD who require revascularization; however, results from recent trials such as FREEDOM have shown that patients with diabetes and CAD may benefit from newer-generation stents, he said.
Farkouh said that while patients with extensive disease do better with coronary artery bypass grafting (CABG) in the event of revascularization, there are many patients with diabetes who would have a relatively good quality of life if treated with percutaneous coronary intervention (PCI).
"Even though the rates of stent thrombosis and repeat revascularization continue to decline with [newer-generation] stents, it's unlikely that another trial will be, at this point, conducted through any federal agency. It is time for the PCI community to focus on improving outcomes post-PCI by optimizing risk factor control and for the surgeons to reduce perioperative stroke,” Farkouh said. “If CABG is not an option based on the risk or the preference of a well-informed patient, either PCI or [optimal medical therapy] is an option. PCI should be performed when symptom relief is the driver; if one survives, they will enjoy a very reasonable quality of life.” – by Dave Quaile
Reference:
Farkouh ME. The Preferred Procedures in People with ACS & Diabetes. Presented at: Heart in Diabetes Medical Conference; July 14-16, 2017; Philadelphia.
Disclosure: Farkouh reports receiving research support from Amgen.