A new study has found that diabetic patients who undergo coronary artery bypass surgery and not stenting have a 30 percent reduced risk of death.
The findings are significant and have public health implications because of the sheer size of the difference in outcomes, according to the researchers at St. Michael's Hospital. Heart disease is the No. 1 killer of people with diabetes, and diabetics represent one-quarter of all patients who undergo coronary artery procedures. The number of people with diabetes is rising steadily as the population ages and becomes more sedentary. "Although bypass surgery is more invasive than stenting, it is imperative that physicians and patients realize that long term mortality reduction is best achieved with bypass surgery," said Dr. Subodh Verma, a cardiac surgeon and principal author of the paper.
Whether diabetics fare better under coronary artery bypass surgery, known as CABG, or the angioplasty-stent procedure known as percuataneous coronary intervention, or PCI, has been the topic of intense debate, particularly from a scientific, social and financial perspective. Therefore, Dr. Verma and Dr. Jan Friedrich, an intensivist at St. Michael's, decided to conduct a meta-analysis of all existing randomized control trials comparing the two procedures. Their results appeared online in the journal Lancet Diabetes and Endocrinology on Friday. It's not known exactly why diabetic patients live longer after bypass surgery compared to stents, even in the contemporary age of "drug-eluting stents," which are coasted with medication that is slowly released to help prevent the growth of scar tissue in the artery lining. Dr. Verma said it may be related to the fact that diabetics have extensive and diffuse blockages that are best treated by bypassing those areas altogether.