Two Treatments to Unblock Arteries in Diabetes

Diabetes patients with heart disease benefited from both angioplasty and bypass surgery

(RxWiki News) In some cases, diabetes patients may turn to surgery and other procedures to treat their heart problems. There are many different procedures to treat any number of heart-related issues, and researchers have been curious which one is best for diabetes patients with narrowed arteries.

According to past studies, coronary artery bypass graft (CABG) surgery has generally been the treatment of choice over angioplasty for diabetes patients with multiple arteries that are blocked or narrowed. However, these studies were based on older data, and angioplasty — which uses a balloon at the end of a catheter to open blood vessels — has since improved.

A recent study found that, while CABG may provide slightly better short-term improvements than angioplasty, both have similar long-term benefits.

"Ask your cardiologist about the risks and benefits of your treatment."

Mouin Abdallah, MD, of Saint Luke’s Mid America Heart Institute in Kansas City, and colleagues evaluated the risks and benefits of these two revascularization strategies in patients with diabetes and multi-vessel coronary artery disease (also called coronary arteriosclerosis).

For this study, 947 patients received CABG surgery and 953 had percutaneous coronary intervention (PCI) using drug-eluting stents.

The researchers analyzed data on these patients who had their health assessed at the beginning of the study. Participants were from 18 different countries and had an average age of 63. About three out of four of the participants were men.

These patients underwent procedures between 2005 and 2010, as part of a trial called Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM).  About eight out of 10 patients had coronary artery disease in three vessels.

During CABG, doctors take a healthy artery or vein from the body and connect, or graft, it to a blocked coronary artery. This grafted blood vessel bypasses, or goes around, the blocked artery to restore blood flow to the heart.

During PCI (also called coronary angioplasty), doctors insert a catheter (thin flexible tube) into a blood vessel in the groin or arm. They guide it to the blockage and inflate a small balloon. Once the balloon compresses the plaque, a stent (mesh tube) is placed in the blood vessel to hold it open and restore blood flow.

At two years of follow-up, the researchers observed that the CABG group had more benefits than the PCI group in terms of quality of life, physical limitations and angina (chest pain) frequency.

The researchers noted that angina relief was slightly better with CABG than PCI, especially among patients with the most severe angina at baseline, so CABG may be the preferred initial revascularization strategy for those patients.

The proportion of angina-free patients in the CABG group versus the PCI group was 84 percent versus 78 percent at six months, 83.5 percent versus 79.5 percent at 12 months and 83 percent versus 81 percent at two years.

On the other hand, Dr. Abdallah and colleagues mentioned that patients may not wish to face the “...increased rate of stroke, as well as the well-recognized longer recovery period with CABG surgery.”

After two years of follow-up, the researchers observed no consistent differences between the two treatment strategies.

"Our study provides reassurance that there are not major differences in long-term health status and quality of life between the two treatment strategies,” the authors wrote.

“Nonetheless, it is important for patients to recognize that the similar late quality-of-life outcomes with PCI and CABG in the FREEDOM trial were achieved with higher rates of antianginal medication [calcium channel blockers and long-acting nitrates] use and the need for more frequent repeat revascularization procedures among the PCI group," they wrote.

Calcium channel blockers include amlodipine (brand name Norvasc), diltiazem (Cardizem-several forms, Cartia XT, Dilacor XR, Dilt-CD, Diltzac, Taztia XT, Tiazac), isradipine (DynaCirc CR), nicardipine (Cardene, Cardene SR), nifedipine (Procardia, Procardia XL, Adalat, Adalat CC, Afeditab CR, Nifedical XR, Nifeditab CR), nisoldipine (Sular) and verapamil (Calan, Isoptin, Verelan, Covera).

This study was published in the October 16 issue of JAMA. This study was supported by grants from the National Heart, Lung, and Blood Institute. Cordis and Boston Scientific provided the stents; Eli Lilly provided abciximab and an unrestricted research grant; and Sanofi-Aventis and Bristol-Myers Squibb provided clopidogrel.

Review Date: 
October 15, 2013