Bypass surgery beats angioplasty for people with diabetes

For almost two decades research has suggested that people with diabetes and multiple clogged arteries live longer and have fewer heart attacks if they undergo bypass surgery instead of angioplasty. Yet many of those people continue to be treated by angioplasty, since many doctors remain unaware of the evidence, or unconvinced by it. Now a major new study, out this week in the New England Journal of Medicine should finally settle the matter in bypass's favor.

In the new study, researchers divided 1,900 people with diabetes plus multiple clogged arteries into two groups. About half underwent coronary artery bypass graft surgery (CABG), in which heart surgeons bypass the blockage by grafting a length of healthy vein or artery taken from elsewhere in the body. The other half underwent angioplasty (also called percutaneous coronary intervention, or PCI), in which an interventional cardiologist snakes a catheter with a balloon up into the clogged section of the coronary artery, inflates it to push the blockage aside, and then leaves a cylindrical, metal stent behind to keep the artery propped open. It was the largest such study to date, using the most up-to-date and accepted practices for each.

After five years, 18.7 percent of the bypass patients had died or had a heart attack or stroke, compared with 26.6 percent of those who underwent angioplasty. That represents an impressive 30 percent reduced risk for bypass surgery over angioplasty. The finding jibes with many earlier, smaller prior studies.

An editorial accompanying the study concluded that it "provides compelling evidence of the comparative effectiveness of CABG versus PCI in patients with diabetes and multivessel coronary artery disease." And it also points out that one reason angioplasty rates continue to be so high is that doctors often rush patients into the procedure without fully explaining it's limitations or discussing alternatives.

That is a problem we have long warned heart patients about. For details, see our story, Too Much Angioplasty. If you do need bypass surgery, use our heart surgeon Ratings to find a practice in your community with low complication and high success rates.

Sources
Strategies for Multivessel Revascularization in Patients with Diabetes [New England Journal of Medicine]

Compelling Evidence for Coronary-Bypass Surgery in Patients with Diabetes [New England Journal of Medicine]

—Joel Keehn