In a nutshell
This study compared two heart interventions for people with coronary heart disease and type 2 diabetes (T2D). It found that coronary artery bypass grafting (CABG) led to better long-term outcomes than placing a stent in these patients.
Some background
Coronary heart disease (CHD) is a condition in which the arteries which supply blood to the heart are clogged with plaque. Left untreated, CHD can lead to a heart attack. People with T2D are more likely to develop CHD. Both conditions are related to obesity, and T2D also increases inflammation which can promote plaque build-up in the arteries.
There are several treatments for CHD. CABG is a type of open-heart surgery which involves using a blood vessel from somewhere else in the body to create a wider passage for blood to the heart muscle. Percutaneous coronary intervention (PCI) is a less invasive procedure. A small tube is threaded from the thigh or the arm up to the heart. A balloon inflates to widen the artery, and then a stent is left to hold it open.
Previous reviews have found CABG leads to longer overall survival than PCI. However, these analyses did not focus on people with both CHD and T2D. Also, in these studies, the PCIs used older bare-metal stents. Newer stents contain medications that discourage the artery wall from growing over the stent. It is not clear whether CABG or PCI is currently a better treatment for patients with both CHD and T2D.
Methods & findings
This review included 9 studies of 4566 patients with both T2D and CHD. 2266 patients were assigned to CABG, while the other 2300 received PCI.
Patients treated with CABG had 41% better survival than those treated with PCI. Even compared to PCI with newer drug-eluting stents, CABG still led to a 50% better survival.
CABG and PCI had similar survival at 1 month, 1 year, and 3 years after the surgery or intervention. CABG had better survival than PCI after five years in 3 out of 6 trials. 2 long-term trials found CABG continued to have better survival ten years after the intervention.
Patients treated with CABG were 56% less likely to die due to heart disease. They also had a 2.68 times lower risk of needing a second heart surgery or intervention. However, patients treated with PCI using drug-eluting stents had a 49% lower risk of stroke.
The bottom line
This study found that CABG heart surgery had better outcomes than PCI for people with coronary heart disease and diabetes.
The fine print
There were differences in the designs of the 9 studies in this review, which can complicate combining data.
Published By :
Clinical cardiology
Date :
Jun 05, 2021
