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Efficacy of Revascularization Strategies Similar in Diabetes

PCI plus stenting and coronary artery bypass have similar results in coronary artery disease

MONDAY, Nov. 30 (HealthDay News) -- In diabetic patients with multivessel coronary artery disease, percutaneous coronary intervention (PCI) plus stenting may be as effective as coronary artery bypass grafting (CABG), although the risk of repeat revascularization is higher with PCI, according to a study published online Nov. 25 in the Journal of the American College of Cardiology.

Akhil Kapur, M.D., from the London Chest Hospital, and colleagues randomly assigned 510 diabetic patients with multivessel or complex single-vessel coronary artery disease to PCI plus stenting or CABG.

At one year of follow-up, the researchers found that the PCI and CABG groups had a similar likelihood of all-cause mortality, myocardial infarction, and stroke (13.0 versus 10.5 percent; hazard ratio, 1.25). When the subset of patients who received drug-eluting stents was compared with patients who underwent CABG, the rates were 11.6 versus 12.4 percent; hazard ratio, 0.93. The PCI and CABG groups had an identical risk of all-cause mortality (3.2 percent). The likelihood of death, myocardial infarction, stroke, or repeat revascularization was significantly higher in the PCI group (19.3 versus 11.3 percent; hazard ratio, 1.77).

The trial "is the first randomized trial of coronary revascularization in diabetic patients, but the one-year results did not show that PCI is non-inferior to CABG," Kapur and colleagues conclude. "However, the trial did show that multivessel PCI is feasible in patients with diabetes, but longer-term follow-up and data from other trials will be needed to provide a more precise comparison of the efficacy of these two revascularization strategies."

The study was funded by unrestricted research grants from Eli Lilly, Cordis Johnson & Johnson, Bristol-Myers Squibb, Sanofi-Aventis, and the Hammersmith Hospitals Special Trustees. Further support was obtained from Boston Scientific, Medtronic, Guidant, and Jomed. Several authors reported financial or advisory relationships with these companies.

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