Drug-eluting stent vs bypass grafting in diabetic patients with coronary artery disease

This article investigated the safety and effectiveness of percutaneous coronary intervention with drug-eluting stent (PCI-DES) vs coronary artery bypass graft (CABG) for patients with diabetes mellitus (DM). 

The authors concluded that CABG was better than PC-DES in these patients. 

DM is a disorder where the body can no longer make and use insulin correctly so that blood sugar rises. Patients with DM are at increased risk of developing heart disease due to the sugar damaging their arteries.

Coronary artery disease (CAD) involves narrowing or blockages in the arteries of the heart. Current treatment options for CAD include PCI-DES. This involves placing a stent in the blocked artery to open it back up. The other option is CABG. This bypasses the blockage with a graft. Unfortunately, both treatments have high side effects after surgery for patients with DM. Which of these two procedures is better in patients with DM and CAD remains under investigation.

The study analyzed 6 other trials. 5,013 patients with DM and CAD were included overall. Patients were divided into two groups. Group 1 underwent PCI (2510). Group 2 underwent CABG (2503).

Group 1 had a 12% increased risk of developing major cardiovascular events (MACEs) compared to group 2. These include heart attack, stroke or death. Group 1 also had an 85% increased risk of developing major cardiac and cerebrovascular events. These included MACEs plus repeat surgery on blood vessels.

PCI-DES was also associated with a 15% increased risk of having a stroke, a 48% higher risk of having a heart attack and a 3.23 times higher risk of having a repeat stent put in compared with group 2. There was no difference between the two groups in terms of cause of all deaths. 

The authors concluded that CABG is a safe and effective treatment option for patients with DM and CAD compared with PCI-DES.

This study did not take into account short-term risks. Further studies are needed.