HealthDay News – For patients with type 2 diabetes and coronary artery disease (CAD), coronary artery bypass grafting (CABG) plus optimal medical therapy (OMT) is superior to percutaneous coronary intervention (PCI) plus OMT, according to a study published in the September 6 issue of the Journal of the American College of Cardiology.

G.B. John Mancini, MD, from the University of British Columbia in Vancouver, Canada, and colleagues examined the effect of OMT with or without PCI or CABG on long-term outcomes in patients with type 2 diabetes and stable CAD. The authors conducted a patient-level pooled analysis in 3 federally-funded trials.

The researchers found that CABG + OMT was superior to PCI + OMT for the primary end point (composite of death, myocardial infarction [MI], or stroke; hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.59-0.85), death (HR: 0.76; 95% CI: 0.60-0.96), and MI (HR: 0.50; 95% CI: 0.38-0.67) during a median follow-up of 4.5 years, but not for stroke (HR: 1.54; 95% CI: 0.96-2.48). 


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Compared with OMT alone CABG + OMT was also superior for prevention of the primary end point (HR: 0.79; 95% CI: 0.64-0.97) and MI (HR: 0.55; 95% CI: 0.41-0.74). In patients with 3-vessel CAD and for those with normal left-ventricular ejection fraction, CABG + OMT was superior to PCI + OMT for the primary end point (HRs: 0.72 [95% CI: 0.58-0.89] and 0.71 [95% CI: 0.58-0.87], respectively).

“CABG + OMT reduced the primary end point during long-term follow-up in patients with type 2 diabetes and stable CAD, supporting this as the preferred management strategy,” the authors wrote.

Disclosures: Several authors disclosed financial ties to the biopharmaceutical industry.

References

  1. Bangalore S. Applicability of the COURAGE, BARI 2D, and FREEDOM trials to contemporary practice. J Am Coll of Cardiol. 2016;68(10):996-998. doi:10.1016/j.jacc.2016.06.020.
  2. Mancini GBJ, Farkouh ME, Brooks MM, et al. Medical treatment and revascularization options in patients with type 2 diabetes and coronary disease. J Am Coll Cardiol. 2016;68(10):985-995. doi:10.1016/j.jacc.2016.06.021.