AHA: CABG Tops PCI in Diabetes, Advanced CAD
Reduced rates of death, MI for patients with diabetes, multivessel coronary artery disease
MONDAY, Nov. 5 (HealthDay News) -- For patients with diabetes and multivessel coronary artery disease, coronary artery bypass grafting (CABG) is associated with better outcomes than percutaneous coronary intervention (PCI) with drug-eluting stents, according to a study published online Nov. 4 in the New England Journal of Medicine to coincide with presentation at the American Heart Association's Scientific Sessions 2012, held from Nov. 3 to 7 in Los Angeles.
Michael E. Farkouh, M.D., from the Mount Sinai School of Medicine in New York City, and colleagues conducted a randomized trial in which 1,900 patients at 140 international centers, who had diabetes and multivessel coronary artery disease, were assigned to undergo either PCI with drug-eluting stents or CABG. Participants were followed for at least two years.
The researchers found that the primary outcome (a composite of all-cause death, nonfatal myocardial infarction, or nonfatal stroke) occurred significantly more frequently in the PCI group than in the CABG group (five-year rates of 26.6 and 18.7 percent, respectively; P = 0.005). The benefit in the CABG group was attributable to differences in the rates of myocardial infarction (P < 0.001) and all-cause mortality (P = 0.049). Stroke was more frequent in the CABG group than in the PCI group (five-year rates of 5.2 and 2.4 percent, respectively; P = 0.03).
"For patients with diabetes and advanced coronary artery disease, CABG was superior to PCI in that it significantly reduced rates of death and myocardial infarction, with slightly higher rates of stroke," the authors write.
Cordis, Johnson & Johnson, and Boston Scientific provided the stents for the study; Eli Lilly provided abciximab and an unrestricted research grant; and Sanofi-Aventis and Bristol-Myers Squibb provided clopidogrel.