CABG not PCI for adults with diabetesBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7610 (Published 12 November 2012) Cite this as: BMJ 2012;345:e7610
Coronary artery bypass grafting (CABG) is better than percutaneous coronary intervention (PCI) for adults with diabetes and multivessel coronary artery disease. In a definitive trial, those treated with CABG lived significantly longer and had significantly fewer myocardial infarctions than those treated with state of the art drug eluting stents (deaths from any cause 10.9% v 16.3%; myocardial infarctions 6.0% v 13.9%). CABG was associated with a higher risk of stroke, but the authors reported a net benefit of 7.9 percentage points in an analysis combining all three outcomes at five years (18.7% v 26.6%; 95% CI around the absolute benefit 3.3 percentage points to 12.5 percentage points)⇑.
The new trial recruited more people with diabetes than all previous trials combined, says a linked editorial (doi:10.1056/NEJMe1212278). The results are clear, and they should lay to rest a long running controversy. The US National Heart, Lung, and Blood Institute recommended CABG for people with diabetes 17 years ago. But practice failed to follow the institute’s lead, and percutaneous coronary intervention remained a popular option, despite growing evidence of inferior outcomes.
The adults in this trial had extensive coronary artery disease in at least two vessels and usually three. They were treated according to modern protocols for both CABG and PCI. They had the best available drug regimens during and after the procedure. Doctors can no longer ignore the evidence and should take steps to bring practice into line, says the editorial. Discussions with patients should start well before diagnostic angiography, and they should preferably involve the patients’ relatives and a multidisciplinary heart team.
Cite this as: BMJ 2012;345:e7610