CABG Again Outperforms PCI in Patients with Diabetes

In patients with diabetes and heart disease, coronary artery bypass grafting reduces cardiovascular events more effectively than PCI with drug-eluting stents, according to a study presented at the American Heart Association meeting and published in the New England Journal of Medicine.

Some 1900 diabetic patients with multivessel disease were randomized either to undergo PCI with drug-eluting stents or CABG.

During roughly 4 years' follow-up, the primary composite outcome — death from any cause, nonfatal MI, and nonfatal stroke — occurred more often with PCI than with CABG (5-year event rate: 27% vs. 19%). In particular, death and MI were more common with PCI, while stroke was more common with CABG.

In Journal Watch Cardiology, Harlan M. Krumholz calls the observed superiority of CABG a "blockbuster result." He adds: "The excess risk for stroke, however, may give some people pause. The issue is ripe for shared decision making; these findings will greatly benefit patients and their doctors working together to make well-informed choices."