Related Experiment Videos
Clinical trials of revascularization therapy in diabetics
1Department of Medicine, University of Pittsburgh, Pennsylvania 15261, USA.
Insights
Diabetic patients with multivessel coronary disease benefit from coronary artery bypass graft surgery (CABG) over percutaneous transluminal coronary angioplasty (PTCA), showing improved long-term survival and reduced cardiac mortality, especially with internal mammary artery grafts.
Area of Science:
- Cardiology
- Diabetology
- Surgical Innovation
Background:
- Diabetic patients face higher cardiovascular risks and poorer outcomes post-revascularization.
- Previous studies indicated potential differences in treatment efficacy between diabetic and non-diabetic patients.
Purpose of the Study:
- To compare the long-term effectiveness of coronary artery bypass graft surgery (CABG) versus percutaneous transluminal coronary angioplasty (PTCA) in diabetic patients with multivessel coronary disease.
- To analyze the impact of revascularization strategy on cardiovascular morbidity and mortality in this high-risk group.
Main Methods:
- Analysis of data from major randomized trials, including the Bypass Angioplasty Revascularization Investigation (BARI) and Emory Angioplasty Versus Surgery Trial (EAST).
- Comparison of long-term survival and cardiac mortality rates between CABG and PTCA groups, stratified by diabetic status and graft type.
Main Results:
- Diabetic patients with multivessel coronary disease demonstrated a significant long-term survival advantage with CABG compared to PTCA.
- The benefit of CABG was primarily driven by improved cardiac mortality and was linked to the use of internal mammary artery grafts.
- CABG significantly reduced the risk of death after myocardial infarction in diabetic patients, an effect not observed in non-diabetic patients.
Conclusions:
- Coronary artery bypass graft surgery (CABG) offers superior long-term survival and reduced cardiac mortality for diabetic patients with multivessel coronary disease compared to PTCA.
- The use of internal mammary artery grafts is crucial for this observed benefit in diabetic patients.
- CABG may provide a protective effect against mortality post-myocardial infarction in diabetic individuals.
Abstract:
Diabetic patients are a high-risk group for cardiovascular morbidity and mortality, with poorer long-term outcomes, with or without revascularization, than non-diabetic patients. Results from the Bypass Angioplasty Revascularization Investigation (BARI) trial, the largest randomized study of coronary revascularization strategies, showed that diabetic patients with multivessel coronary disease who were undergoing an initial revascularization procedure had a significant long-term survival advantage with coronary artery bypass graft surgery (CABG) compared with percutaneous transluminal coronary angioplasty (PTCA). The 8-year follow-up data from the Emory Angioplasty Versus Surgery Trial (EAST) study, the other major US trial of CABG versus PTCA, and results of other clinical trials that enrolled similar patients are consistent with an advantage for CABG in diabetic patients but not for nondiabetic patients. This benefit is entirely a result of improved cardiac mortality. It is limited to patients receiving an internal mammary artery (IMA) graft and is apparent earlier in insulin-treated patients. The benefit of CABG in diabetic patients may be significantly related to a protective effect on mortality after myocardial infarction, because CABG greatly reduced the risk of death after spontaneous Q-wave myocardial infarction in BARI-eligible diabetic patients (relative risk 0.09, P<0.001), an effect not seen in non-diabetic patients.