SCAI: CARDia Data Find Diabetic Patients With Complex Heart Disease Can Safely Choose PCI

Main Category: Heart Disease
Also Included In: Diabetes;  Clinical Trials / Drug Trials
Article Date: 02 Sep 2008 - 0:00 PDT

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Patients with both diabetes and advanced blockages in at least three heart vessels will find good news in new findings announced from the CARDia trial, says The Society for Cardiovascular Angiography and Interventions (SCAI). The one-year findings of the new study indicate that these patients can safely choose to undergo angioplasty and stenting rather than open-heart surgery.

At the European Society of Cardiology Congress (Munich, Germany), investigators from the United Kingdom presented the results of CARDia (Coronary Artery Revascularization in Diabetes), a clinical trial comparing percutaneous coronary intervention (PCI) vs. open-heart surgery in patients typically considered to be poor candidates for angioplasty and stenting. Since the combination of diabetes and multi-vessel coronary artery disease has long been considered the domain of surgeons, their findings surprised some: The patients who underwent PCI rather that surgery did just as well as the surgery patients on the primary endpoint of death, heart attack, and stroke. In addition, the PCI patients experienced fewer strokes and less bleeding.

This finding differs from earlier trials comparing PCI and surgery in these patients, perhaps because drug-eluting stents have been added to the mix, suggest SCAI leaders. "The take-away message is that diabetic patients with complex coronary artery disease may now be able to choose angioplasty and stenting over bypass surgery," says Dr. Bonnie Weiner, SCAI Immediate Past President, Professor of Medicine, and Director of Interventional Cardiology Research at St. Vincent Hospital at Worcester Medical Center (Worcester, MA). "It's important to realize that this is one trial and the first-year findings, but it's a good sign for patients because it could ultimately broaden their options."

CARDia also examined whether, after undergoing PCI or surgery, patients required a repeat procedure. The difference in repeat revascularization between PCI and bypass surgery was very small but statistically significant, despite an unusually low rate for both groups (9.9% for PCI vs. 2.0% for bypass; p=0.001). Further, when the patients who received drug-eluting stents (rather than bare metal stents or the entire study population) were specifically analyzed, the difference in revascularization in the PCI group was even lower, and the difference in the rates of repeat revascularization was less important (7.3% for PCI vs. 2.0% for bypass; p=0.013). This represented about two-thirds of the study population and more closely reflects current practices.

"When you compare only the patients who had angioplasty with drug-eluting stents with the bypass surgery patients, you find very similar repeat revascularization rates," says Dr. Weiner. "We'll want to see if these findings continue as the follow-up proceeds since the surgery patients are less likely to have repeat revascularization procedures this early, but it's a very good sign for patients who are candidates for PCI and prefer it because it is less invasive and easier to recover from than surgery. In our view, this is very good news for patients because it gives them more options for their care."

About SCAI

Headquartered in Washington, D.C., The Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in more than 60 countries. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's annual meeting has become the leading venue for education, discussion, and debate about the latest developments in this dynamic medical specialty. SCAI's new patient and physician education program, Seconds Count, offers comprehensive information about cardiovascular disease. For more information about SCAI and Seconds Count, visit http://www.scai.org or http://www.seconds-count.org.

Society for Cardiovascular Angiography and Interventions (SCAI)
http://www.scai.org