Home > Interventional Cardiology, Journal Club > Journal Club 7 November 2012

Journal Club 7 November 2012


Strategies for Multivessel Revascularization in Patients with Diabetes





In some randomized trials comparing revascularization strategies for patients with
diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than
percutaneous coronary intervention (PCI). We sought to discover whether aggressive
medical therapy and the use of drug-eluting stents could alter the revascularization
approach for patients with diabetes and multivessel coronary artery disease.


In this randomized trial, we assigned patients with diabetes and multivessel coronary
artery disease to undergo either PCI with drug-eluting stents or CABG. The patients
were followed for a minimum of 2 years (median among survivors, 3.8 years). All
patients were prescribed currently recommended medical therapies for the control of
low-density lipoprotein cholesterol, systolic blood pressure, and glycated hemoglobin.
The primary outcome measure was a composite of death from any cause, nonfatal
myocardial infarction, or nonfatal stroke.


From 2005 through 2010, we enrolled 1900 patients at 140 international centers.
The patients’ mean age was 63.1±9.1 years, 29% were women, and 83% had threevessel
disease. The primary outcome occurred more frequently in the PCI group
(P = 0.005), with 5-year rates of 26.6% in the PCI group and 18.7% in the CABG
group. The benefit of CABG was driven by differences in rates of both myocardial
infarction (P<0.001) and death from any cause (P = 0.049). Stroke was more frequent
in the CABG group, with 5-year rates of 2.4% in the PCI group and 5.2% in the
CABG group (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 a higher rate of stroke.

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