Drug-eluting stents, CABG ‘equivalent’ in diabetic multivessel disease
MedWire News: Drug-eluting stents and coronary artery bypass graft (CABG) surgery are equivalent for preventing major vascular events in patients with diabetes mellitus and multivessel disease, analysis of registry data suggests.
The study aimed to compare “real-world” outcomes of two different approaches to the management of coronary narrowing in diabetic patients: Off-pump CABG, which is often considered the preferred strategy in this high-risk group, or percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES).
In all, 208 consecutive patients with diabetes and multivessel disease were treated at the National Cardiovascular Center in Osaka, Japan, between August 2004 and December 2006.
The choice of treatment for each patient was made by consensus among the cardiologists and cardiac surgeons; in all, 92 patients received an SES and 116 underwent CABG.
Short-term outcomes were worse in the CABG group, with seven major adverse cardiac and cerebrovascular events (MAACEs) occurring in the first 30 days compared with none in the SES group.
MAACEs in the CABG group included one death from sepsis, two nonfatal myocardial infarctions, three cerebrovascular events, and three revascularizations. There was just one definite stent thrombosis in the SES group and the overall incidence of stent thrombosis (definite, probable, or possible) was very low, at 2.1%.
After a mean follow-up of 42 months, the rate of repeat revascularization was significantly higher in the SES group (21% vs 6.9 with CABG), whereas the rate of cerebrovascular events was higher with CABG (11.2% vs 3.2% with SES).
Accordingly, the cumulative prevalence of MAACEs at 3 years was comparable between the two groups (27% with SES vs 23% with CABG). This remained the case in subgroup analyses.
Yu Kataoka and colleagues from Japan’s National Cardiovascular Center say their study suggests that the use of SES in diabetic patients with multivessel disease “seems to be safe under the conditions of prolonged dual antiplatelet therapy and is an effective therapeutic equivalent to off-pump CABG.”
Writing in the Circulation Journal, they conclude: “Although randomized studies with a larger number of patients and longer follow-up are needed to confirm the equivalency of SES to off-pump CABG in such patients, the present study provides important and valuable information about their clinical management, and suggests that PCI using SES is a reasonable therapeutic strategy.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Joanna Lyford