Diabetes With Heart Disease: Bypass vs. Angioplasty
Study found higher quality of life after bypass than with less-invasive angioplasty
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.
"If people with diabetes have severe coronary artery disease with symptoms, they should have a full discussion with their physician about available revascularization procedures. Guidelines give a strong preference to CABG, but treatment has to be individualized," Cohen said.
Zonszein agreed that coronary artery bypass graft is usually "the right procedure to do in patients with diabetes who have symptoms." He added that this study also points out the importance of trying to prevent vascular disease in the first place. Medications to lower cholesterol, blood pressure and blood sugar are all important for people with diabetes, he said.