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Nov 28, 2012

CABG Superior to PCI in Patients with Diabetes

PCI is still risky for patients with diabetes, even with drug-eluting stents.

Coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are two types of revascularization used to restore normal blood flow to the heart. CABG is a surgical procedure in which a healthy artery or vein is connected to a blocked artery in the heart to divert blood and improve blood flow. PCI, on the other hand, is a nonsurgical procedure in which a small balloon is inserted on a thin tube through a blood vessel and inflated to open up blocked arteries. Although guidelines advise CABG over PCI for patients with diabetes, experts wondered if the use of drug-eluting stents during PCI might make this procedure preferable to a CABG.

Drug-eluting stents are inserted into the blocked artery during PCI to keep the artery open following the procedure and prevent the build-up of scar tissue around the stent. In a recent study published in the New England Journal of Medicine, researchers compared the use of PCI with drug-eluting stents to CABG to see if the PCI might, in fact, be safer and more effective in patients with diabetes. However, after assigning 1,900 patients with diabetes to either PCI with a drug-eluting stent or CABG, researchers found that CABG is still the better choice. Risk for heart attack and death was significantly higher among patients receiving PCI, and that key difference makes CABG safer for patients with diabetes.

Based on these findings, CABG remains the preferred approach for revascularization in patients with diabetes. Although PCI is a less invasive approach, CABG is safer when it comes to long-term risks associated with revascularization. 

Questions for You to Consider

  • When is revascularization required?

  • Revascularization is used to treat coronary artery disease – a condition that develops when the major arteries of the heart become narrowed or even blocked. Although lifestyle changes and drugs can help treat coronary artery disease, sometimes more aggressive treatment, like CABG or PCI, is needed to clear blockages and restore blood flow to the heart.

  • Is revascularization common among patients with diabetes?

  • Yes. Because diabetes is a major risk factor for heart disease, many patients with diabetes experience blockage or narrowing of the arteries and require revascularization. In fact, patients with diabetes make up roughly ¼ of all patients undergoing revascularization procedures.

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