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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 comparingpercutaneous coronary intervention (PCI) vs. open-heart surgery in patientstypically considered to be poor candidates for angioplasty and stenting. Sincethe combination of diabetes and multi-vessel coronary artery disease has longbeen considered the domain of surgeons, their findings surprised some: Thepatients who underwent PCI rather that surgery did just as well as the surgerypatients on the primary endpoint of death, heart attack, and stroke. Inaddition, the PCI patients experienced fewer strokes and less bleeding.
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This finding differs from earlier trials comparing PCI and surgery inthese patients, perhaps because drug-eluting stents have been added to themix, suggest SCAI leaders. "The take-away message is that diabetic patientswith complex coronary artery disease may now be able to choose angioplasty andstenting over bypass surgery," says Dr. Bonnie Weiner, SCAI Immediate PastPresident, Professor of Medicine, and Director of Interventional CardiologyResearch 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 theiroptions."
CARDia also examined whether, after undergoing PCI or surgery, patientsrequired a repeat procedure. The difference in repeat revascularizationbetween 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% forbypass; p=0.001). Further, when the patients who received drug-eluting stents(rather than bare metal stents or the entire study population) werespecifically analyzed, the difference in revascularization in the PCI groupwas even lower, and the difference in the rates of repeat revascularizationwas less important (7.3% for PCI vs. 2.0% for bypass; p=0.013). Thisrepresented about two-thirds of the study population and more closely reflectscurrent practices.
"When you compare only the patients who had angioplasty with drug-elutingstents with the bypass surgery patients, you find very similar repeatrevascularization rates," says Dr. Weiner. "We'll want to see if thesefindings continue as the follow-up proceeds since the surgery patients areless likely to have repeat revascularization procedures this early, but it's avery good sign for patients who are candidates for PCI and prefer it becauseit is less invasive and easier to recover from than surgery. In our view, thisis very good news for patients because it gives them more options for theircare."
About SCAI
Headquartered in Washington, D.C., The Society for CardiovascularAngiography and Interventions is a 4,000-member professional organizationrepresenting invasive and interventional cardiologists in more than 60countries. SCAI's mission is to promote excellence in invasive andinterventional cardiovascular medicine through physician education andrepresentation, 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, offerscomprehensive information about cardiovascular disease. For m
