CABG associated with better outcomes than stents in diabetic patients

Among diabetics, coronary artery bypass grafting (CABG) was associated with lower rates of death from any cause, myocardial infarction (MI), or stroke than percutaneous coronary intervention (PCI) with a drug-eluting stent, a study found.

From 2005 to 2010, researchers randomly assigned 1,900 patients with diabetes and multivessel coronary artery disease (83% had three-vessel disease) to undergo either PCI with drug-eluting stents or CABG. The patients were followed for at least two years (median among survivors, 3.8 years). All patients received accompanying treatment for elevated cholesterol, blood pressure or glycated hemoglobin.

Results appeared online Nov. 4 at the New England Journal of Medicine.

Overall, any of the negative outcomes occurred more frequently in the PCI group, with five-year rates of 26.6% in the PCI group and 18.7% in the CABG group (P=0.005). Death from any cause and MI were lower in the CABG group, but strokes were higher, with five-year rates of 2.4% in the PCI group versus 5.2% in the CABG group (P=0.03).

Researchers wrote, “The increased use of internal mammary grafting in these trials has been postulated to play a key role in the improved survival with CABG. When considered together, the data provide a convincing signal that PCI results in increased long-term mortality, as compared with CABG, in patients with diabetes and multivessel coronary artery disease.”

An editorial commented that the trial provides compelling evidence of the comparative effectiveness of CABG versus PCI in this population. “Mortality has been consistently reduced by CABG, as compared with PCI, in more than 4,000 patients with diabetes who have been evaluated in 13 clinical trials,” the editorial stated. “The controversy should finally be settled.”