CABG Plus Optimal Medical Therapy Yields Best Outcomes in Type 2 Diabetes With CAD

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CABG plus optimal medical therapy appears to be the best treatment option in type 2 diabetes with CAD.
CABG plus optimal medical therapy appears to be the best treatment option in type 2 diabetes with CAD.

(HealthDay News) — For patients with type 2 diabetes and coronary artery disease (CAD), coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT) is superior to percutaneous coronary intervention (PCI) plus OMT, according to a study published in the Journal of the American College of Cardiology.

G.B. John Mancini, MD, from the University of British Columbia in Vancouver, Canada, and colleagues examined the effect of OMT with or without PCI or CABG on long-term outcomes in patients with type 2 diabetes and stable CAD. The authors conducted a patient-level pooled analysis in 3 federally-funded trials.

The researchers found that CABG plus OMT was superior to PCI plus OMT for the primary end point (composite of death, myocardial infarction [MI], or stroke; hazard ratio [HR], 0.71; 95% CI, 0.59-0.85), death (HR, 0.76; 95% CI, 0.60-0.96), and MI (HR, 0.50; 95%CI, 0.38-0.67) during a median follow-up of 4.5 years, but not for stroke (HR, 1.54; 95% CI, 0.96-2.48). 

Compared with OMT alone CABG plus OMT was also superior for prevention of the primary end point (HR, 0.79; 95%CI, 0.64-0.97) and MI (HR, 0.55; 95% CI, 0.41-0.74). In patients with 3-vessel CAD and for those with normal left-ventricular ejection fraction, CABG plus OMT was superior to PCI plus OMT for the primary end point (HRs, 0.72 [95% CI, 0.58-0.89] and 0.71 [95% CI, 0.58-0.87], respectively).

"CABG plus OMT reduced the primary end point during long-term follow-up in patients with type 2 diabetes and stable CAD, supporting this as the preferred management strategy," the researchers wrote.

Disclosures: Several authors disclosed financial ties to the biopharmaceutical industry.

Reference

  1. Mancini GBJ, Farkouh ME, Brooks MM, et al. Medical treatment and revascularization options in patients with type 2 diabetes and coronary disease. J Am Coll Cardiol. 2016;68(10):985-995. doi:10.1016/j.jacc.2016.06.021.
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