Coronary Artery Bypass Grafting: Preferred Method of Revascularization in Diabetes

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Coronary artery bypass grafting may be the preferred method of revascularization in patients with diabetes, with lower rates of major adverse cardiac or cerebrovascular events.
Coronary artery bypass grafting may be the preferred method of revascularization in patients with diabetes, with lower rates of major adverse cardiac or cerebrovascular events.

HealthDay News — In patients with diabetes and multivessel coronary artery disease (MV-CAD), coronary artery bypass grafting (CABG) may be the preferred method of revascularization, with lower rates of major adverse cardiac or cerebrovascular events (MACCE), according to a study published in the Journal of the American College of Cardiology.

Krishnan Ramanathan, MB, ChB, from University of British Columbia in Vancouver, Canada, and colleagues assessed the generalizability of results from the FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi-Vessel Disease) trial in real-world practice among patients with diabetes mellitus and MV-CAD by evaluating major cardiovascular outcomes in all patients with diabetes who underwent coronary revascularization between 2007 and 2014 (4661 patients; 2947 with ACS).

The researchers found that at 30 days after revascularization, the odds ratio for MACCE for ACS patients favored CABG (odds ratio, 0.49; 95% CI, 0.34 to 0.71), whereas among patients with stable ischemic heart disease (SIHD), MACCE was not impacted by revascularization strategy (odds ratio, 1.46; 95% CI, 0.71 to 3.01; Pinteraction < .01).

Over the longer term (median follow-up of 3.3 years), the benefit of CABG over PCI no longer varied by acuity of presentation (hazard ratio for MACCE in ACS and SIHD patients, 0.67 [95% CI, 0.55 to 0.81] and 0.55 [95% CI, 0.40 to 0.74], respectively; Pinteraction = .28).

"A well-powered randomized trial of CABG versus PCI in the ACS population is warranted because these patients have been largely excluded from prior trials," the authors write.

Reference

Ramanathan K, Abel JG, Park JE, et al. Surgical versus percutaneous coronary revascularization in patients diabetes and acute coronary syndromes [published online December 19, 2017]. J Am Coll Cardiol. doi: 10.1016/j.jacc.2017.10.029

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