| Two weeks ago, I reported on a prospective | | | | those of non-diabetic patients to narrow again |
| randomized clinical trial that compared coronary | | | | following PCI using balloon angioplasty, with or |
| artery bypass surgery (CABG) with coronary | | | | without the insertion of bare metal stents. |
| artery angioplasty and stent placement | | | | However, recent advances in the development of |
| (percutaneous coronary intervention, or PCI). I | | | | drug-eluting stents and newer anti-clotting drugs |
| noted that, based upon the early results of this | | | | have shown considerable promise in diabetic |
| clinical study, the jury may still be out regarding | | | | patients undergoing PCI with stent placement |
| which of these two treatment approaches to | | | | (among the 10 clinical studies included in this |
| coronary artery narrowing (stenosis) offers the | | | | analysis, all patients receiving PCI underwent |
| best risk-to-benefit equation for most patients. | | | | balloon angioplasty with or without bare metal |
| Now, a new report, just published in The Lancet, | | | | stent placement, and no drug-eluting stents were |
| has analyzed the results of 10 different | | | | utilized). |
| prospective randomized clinical research trials | | | | Fortunately, there are several ongoing prospective |
| comparing CABG with PCI in the treatment of | | | | randomized clinical research trials that will, |
| coronary artery disease affecting multiple | | | | hopefully, shed more light on the coronary artery |
| coronary arteries. | | | | restenosis rate in diabetic patients using the |
| Altogether, the 10 clinical trials evaluated in this | | | | newer drug-eluting stents and glycoprotein IIb/IIIa |
| report included 7,812 patient volunteers. After an | | | | inhibiting drugs. Unfortunately, we will have to |
| average of 6 years of clinical follow-up, 575 of | | | | await the publication of the findings of these |
| the 3,889 (15 percent) patients who underwent | | | | ongoing clinical trials before PCI can truly be |
| CABG died, while 628 of the 3,923 (16 percent) | | | | declared equal to CABG in diabetic patients. |
| patients who underwent PCI died. Therefore, | | | | Therefore, at the present time, patients with |
| overall, there was no difference in survival | | | | diabetes, and especially diabetic patients with |
| between the two treatment groups within 6 | | | | more advanced multi-vessel coronary artery |
| years of coronary artery intervention. However, | | | | disease (as well as diabetic patients with abnormal |
| when the researchers analyzed certain groups of | | | | function of the primary pumping chamber of the |
| patients undergoing coronary artery interventions, | | | | heart, the left ventricle) are more likely to be |
| they discovered that diabetic patients appeared to | | | | advised to undergo CABG instead of PCI; although |
| do much better following CABG, rather than PCI. | | | | an increasing number of favorable-risk diabetic |
| Among the patients with diabetes, survival at 6 | | | | patients with complicated coronary artery disease |
| years after treatment was 30 percent greater | | | | are now being offered PCI with the newer |
| among those diabetic patients who underwent | | | | drug-eluting stents and anti-clotting drugs. |
| CABG when compared to the diabetic patients | | | | As I concluded 2 weeks ago, the ongoing |
| who underwent PCI. Similarly, patients over the | | | | improvements in minimally-invasive PCI have |
| age of 65 also appeared to do better with CABG. | | | | definitely narrowed the gap in clinical outcomes |
| Among patients over the age of 65, survival at 6 | | | | between PCI and CABG over the past 10 to 15 |
| years was 18 percent better in the CABG group | | | | years, and it is no longer clear that CABG (which |
| when compared to the PCI group. For all other | | | | is much more invasive than PCI, and more likely |
| patients, however, there was no statistically | | | | to cause stroke than PCI) offers any significant |
| significant difference in survival at 6 years | | | | survival benefit over PCI, although CABG does |
| between those patients who underwent PCI and | | | | appear to still provide a longer duration of |
| those who underwent the far more invasive | | | | improvement in blood flow to the heart than PCI |
| CABG surgery. | | | | (however, PCI can often be repeated, when |
| Approximately 1.5 million coronary artery | | | | necessary), and CABG may still be more |
| interventions (CABG and PCI) are performed in | | | | appropriate for patients with more advanced |
| the United States each year, and an estimated 25 | | | | cases of multi-vessel coronary artery disease. |
| percent of these patients have diabetes. So, a | | | | Stay tuned, as I will continue to track the results |
| significant number of patients undergoing CABG | | | | of this very important area of clinical research, |
| and PCI also have diabetes. The results of this | | | | and I will keep readers updated as the ongoing |
| analysis are in keeping with the findings of | | | | "CABG vs. PCI" clinical research trials begin to |
| previous studies showing that the coronary | | | | report their results. |
| arteries of diabetic patients are more likely than | | | | |