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CABG Shows Survival Benefits in Patients with Diabetes, CAD

Aug 28, 2013

A coronary artery bypass graft (CABG) may be the preferred treatment strategy for diabetic patients with stable multivessel CAD due to the complete revascularization it provides…. 

Lima et al. compared three different therapeutic options for stable multivessel coronary artery disease CAD in patients with and without diabetes: medical therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG). A total of 611 patients were included in the study with 232 being diabetic and 379 being non-diabetic patients; all patients were diagnosed with multivessel CAD. Patients were randomized to either of the three treatment groups: CABG, PCI, or MT. They were then followed up 10 years later to determine the overall and cardiac mortality rates among each treatment group.

Results showed that more deaths were present in patients with diabetes than those without the disease. Diabetics had a 32.3% mortality rate, whereas non-diabetics had a 23.2% mortality rate. In regards to cardiac mortality rates after a 10-year follow-up, diabetics had a 19.4% rate, while non-diabetics had a 12.7% rate. When comparing the mortality rates among the different treatment groups, it was found that CABG had the lowest rate with 27.5%, while medication therapy had the highest rate of 37.5%. This pattern was similar when comparing the cardiac mortality rates between the different groups. In regards to the results, the authors of the study explain that the "apparent positive effect of CABG among [the] population despite diabetes status could reside in the completeness of revascularization and the use of [the left internal mammary artery] in this subset of patients."

In conclusion, diabetes patients had the highest overall and cardiac mortality rates when compared to non-diabetics. However, those treated for their CAD with a CABG had better treatment outcomes.

Lima EG et al. Impact of diabetes on 10-year outcomes of patients with multivessel coronary artery disease in the Medicine, Angioplasty, or Surgery Study II (MASS II) trial.Am Heart J. 2013;166:250-257