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Diabetes With Heart Disease: Bypass vs. Angioplasty

Study found higher quality of life after bypass than with less-invasive angioplasty

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A diabetes expert explained why the less-invasive treatment isn't necessarily the best option.

"PCI tends to fix only a little bit at a time, but people with diabetes have very diffuse disease," said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City. "It's usually not one single blood vessel, it's all over. And, you don't see the full obstruction, but if you look at the blood vessels, they're quite diseased, which is probably part of the inflammatory process. The disease process is different in people with diabetes, and that's why the more aggressive treatment works better."

Although previous studies have found that bypass surgery is often the better choice for people with diabetes, Cohen and his colleagues felt that because of the improvements in angioplasty and stents, it was time to compare the procedures again.

The investigators recruited 1,900 people with diabetes from 18 countries to participate in the study. Most had type 2 diabetes, and all had known problems in more than one blood vessel. The average age was 63 years, and 72 percent of patients were male.

Study volunteers were randomly assigned to receive either bypass surgery or angioplasty as their initial treatment between 2005 and 2010.

Participants completed questionnaires to evaluate their levels of chest pain (angina), physical limitations and quality of life at the start of the study, one month, six months, 12 months and annually thereafter.

Cohen said that in previously reported results from this trial, there were lower rates of death and fewer heart attacks in the bypass surgery group. The risk of stroke was higher in this group, he noted. However, Cohen added that the overall rate of stroke was small after five years with either treatment.

Between six months and two years after the initial treatment, those who had a coronary artery bypass graft reported less chest pain, fewer physical limitations and better quality of life, according to the study. After two years, no significant differences existed between the two groups with regard to these patient-reported outcomes.

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