Not All Heart Surgeries for Diabetes Patients Were Equal

Diabetes patients with heart disease may have better overall results with coronary artery bypass grafting than with angioplasty

(RxWiki News) Two procedures often used to treat diabetes patients with heart disease are bypass grafting surgery and angioplasty. Is one better than the other?

Adults with diabetes are two to four times more likely to have cardiovascular disease or a stroke than adults without diabetes, according to the American Heart Association. Two leading operations to open blocked arteries are coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) — also known as angioplasty.

A new study found that diabetes patients who underwent CABG had a lower combined risk of heart attack, stroke and dying than those who had PCI. They were also much less likely to need another heart surgery.

James M. Brophy, MD, with McGill University Health Center in Montreal, Canada, and colleagues studied past research comparing PCI to CABG.

These past studies represented more than 4,600 patients who had blocked arteries in their hearts.

The review showed that the combined risk for death, nonfatal heart attack and stroke for diabetes patients was 33 percent higher for those who underwent PCI than those who had CABG.

Dr. Brophy and team found that the risk of dying was 44 percent greater among PCI patients than in CABG patients. The risk of stroke, however, was 44 percent greater among those who underwent CABG.

The authors noted that the largest advantage of CABG was in avoiding repeat surgeries to restore blood flow (revascularization) to blocked arteries.

With diabetes, blood sugar levels are higher than normal. The condition can cause artery walls to become sticky. That can cause more blood fats (such as cholesterol and triglycerides) to build up in blood vessels. If too much builds up, a blockage can form, depriving parts of the body the oxygen and nutrients they need.

To restore blood flow with CABG, doctors take a healthy artery or vein from another part of the body. It may be taken from the leg, for instance. The vein is then connected — or grafted — so it bypasses the blocked artery and brings blood flow back to the heart.

PCI involves threading a thin tube called a catheter through the blood vessels to the site of the blockage and inflating a small balloon to widen the artery. Then, a stent (small mesh tube) is inserted to keep the vessel open.

Dr. Brophy and colleagues stressed that a doctor’s judgment is important when it comes to choosing a revascularization method.

“There is a need for further data as these techniques continue to evolve and for a personalized evaluation of the right revascularization technique for the right diabetic patient,” the authors concluded.

This study was published Nov. 18 in Annals of Internal Medicine.

The Fonds de recherche du Québec-Santé, a nonprofit agency, funded the research. The authors disclosed no conflicts of interest.

Review Date: 
November 18, 2014