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Oct 18, 2013

Comparing Life-Saving Procedures from a Patient Perspective

Trial compares quality of life in diabetic patients undergoing revascularization procedures CABG and PCI.

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are common treatments for severe coronary artery disease. These life-saving procedures are used to open narrowed or blocked blood vessels that supply blood to the heart, which can help prevent a heart attack. PCI is much less invasive than CABG but, surprisingly, a recent study found that CABG may be safer and more effective in patients with diabetes.

This study was published in the Journal of the American Medical Association as part of the FREEDOM trial (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease). Between 2005 and 2010, 1,900 diabetic patients from 18 different countries enrolled in this trial, each of which needed treatment for narrowed or blocked arteries. Patients were assigned to receive either CABG or PCI with a drug-eluting stent, which helps keep vessels open after the procedure, and followed for up to five years.  

Interestingly, previous analysis of the FREEDOM trial showed that CABG carried lower risk of death and heart attack but a higher risk of stroke compared to PCI. But researchers then wondered if there was a difference in efficacy of the procedures from a patient perspective. In their most recent analysis, investigators compared self-reported assessments of chest pain, physical limitations and quality of life following CABG and PCI. They found that compared to PCI, CABG provided slightly better health outcomes and quality of life for patients. However, this benefit was relatively small and existed only in the two years of follow-up (not in years 3–5).

Overall, the FREEDOM trial provides key information about the treatment of patients with diabetes and heart disease. Most importantly, although researchers compared CABG and PCI, both procedures provided substantial health benefits for patients with diabetes in both the short and long-term. These findings are extremely encouraging, as many patients with diabetes will develop heart disease and require treatment at some point in time.

Also, this study helped us understand the pros and cons of CABG and PCI in diabetic patients. CABG may carry less risk of death and heart attack, but it increases risk of stroke compared to PCI. And CABG may improve certain outcomes and quality of life, but only for a short period of time. Thus, it’s important that patients work closely with their doctors to weigh the possible risks and benefits of each procedure to determine which treatment is right for them.

Questions for You to Consider

  • What is percutaneous coronary intervention (PCI)?

  • Percutaneous coronary intervention (often referred to as balloon angioplasty or simply angioplasty) is often recommended for patients diagnosed with diseased arteries of the heart (coronary arteries) or for patients suffering a heart attack. Percutaneous coronary intervention includes a variety of procedures developed to compress fat and cholesterol build-up in the arteries, known as plaque deposits, to help increase the size of narrowed or blocked arteries and improve blood and oxygen flow to the heart.
  • What are "revascularization" procedures?

  • In some cases, the blockage in the artery cannot be sufficiently reduced with medication alone and a surgical remedy is needed. The less-invasive option is to inflate a balloon catheter in the artery at the point of the blockage to open the channel for blood flow. Often a wire mesh device called a stent is place in the artery to prevent it from closing again. If the blockage is severe or blood flow is reduced in several arteries, coronary artery bypass surgery (CABG) may be needed. This operation involves opening the chest cavity and surgically attaching a new piece of vessel to reroute blood flow around the damaged arteries.



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