Coronary Artery Bypass Surgery Could Be Better Than Catheter And Balloon Intervention For Diabetics And Patients Aged 65-75 Years

Main Category: Cardiovascular / Cardiology
Also Included In: Diabetes;  Medical Devices / Diagnostics
Article Date: 22 Mar 2009 - 1:00 PDT

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A study comparing open coronary artery bypass graft surgery (CABG) with the less invasive catheter/balloon/stent percutaneous intervention (PCI) has revealed that CABG might be a better choice for patients with diabetes and patients aged 65-75 years since it leads to lower mortality. The issues are discussed in an Article published Online First and in an upcoming edition of The Lancet, written by Professor Mark A Hlatky, Stanford University School of Medicine, USA, and colleagues.

CABG - which involves open surgery and a long recovery period - has been compared with the less invasive PCI in many randomised studies, but none has been large enough to determine whether patient outcomes vary importantly according to characteristics such as age, sex, or extent of coronary disease. The investigators from 10 randomised trials collaborated to assess long-term outcomes in 7812 patients to compare the two methods overall and in patient subgroups. PCI was done with balloon angioplasty in six trials and bare-metal stents in four trials.

The researchers found over a median follow-up of nearly six years, overall mortality was similar whether patients received CABG or PCI - 15% of patients given CABG died versus 16% for PCI. However, patients with diabetes were 30% less likely to die if given CABG than if given PCI. Patients aged 65-75 years who had CABG were 18% less likely to die than those who had PCI, while patients younger than 55 years given CABG were 25% more likely to die than those given PCI.

The authors conclude: "Long-term mortality is similar after CABG and PCI in most patients with multivessel coronary artery disease, so choice of treatment should depend on patient preferences for other outcomes. CABG might be a better option for patients with diabetes and patients aged 65 years or older* because we found mortality to be lower in these subgroups."

In an accompanying Comment, David Taggart, Professor of Cardiovascular Surgery, University of Oxford, and Consultant Cardiac Surgeon, John Radcliffe Hospital, Oxford, UK, says: "In patients with more severe coronary artery disease, and especially those with diabetes, CABG is superior in terms of survival and freedom from reintervention. However, SYNTAX** also underlined that PCI is a good option-at least over the shorter term-in patients who are ineligible for or who refuse CABG and also the importance of rigorous secondary prevention in patients who have CABG."

*The authors say that most patients in this group were 65-75 years, with only 5% above 75 years old. It is important to note that this finding is not generalisable to patients over 75 years old.

**SYNTAX= a trial of 1800 patients with left-main and/or three-vessel coronary artery disease who were randomised to PCI or CABG

Source
Tony Kirby
Press Officer
The Lancet
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