Featured Research

from universities, journals, and other organizations

Cardiac bypass surgery superior to non-surgical procedure for adults with diabetes and heart disease

Date:
November 4, 2012
Source:
NIH/National Heart, Lung and Blood Institute
Summary:
Adults with diabetes and multi-vessel coronary heart disease who underwent cardiac bypass surgery had better overall heart-related outcomes than those who underwent an artery-opening procedure to improve blood flow to the heart muscle, according to new results.

Adults with diabetes and multi-vessel coronary heart disease who underwent cardiac bypass surgery had better overall heart-related outcomes than those who underwent an artery-opening procedure to improve blood flow to the heart muscle, according to the results from an international study. The research was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

The study compared the effectiveness of coronary artery bypass graft (CABG) surgery with a non-surgical procedure known as percutaneous coronary intervention (PCI) that included insertion of drug-eluting stents. After five years, the CABG group had fewer adverse events and better survival rates than the PCI group.

Principal investigator Valentin Fuster, M.D., Ph.D., of Mount Sinai School of Medicine in New York City, will present the study findings on Nov. 4 at the American Heart Association's annual meeting in Los Angeles. The findings will appear concurrently online in The New England Journal of Medicine. A companion paper on cost effectiveness will appear online in Circulation.

"These study results confirm that bypass surgery is a better overall treatment option for individuals with diabetes and multi-vessel coronary disease and may assist physicians' efforts to prevent cardiovascular events such as heart attacks and deaths in this high-risk group," explained Gary H. Gibbons, M.D., director of the NHLBI.

In coronary heart disease, plaque builds up inside coronary arteries. This often leads to blocked or reduced blood flow to the heart muscle and can result in chest pain, heart attack, heart failure, and/or erratic heartbeats (arrhythmia). In 2010, nearly 380,000 Americans died from coronary heart disease. Approximately 25 percent to 30 percent of patients needing CABG or PCI have diabetes and multi-vessel coronary heart disease.

In the United States, more than one million procedures (CABG and PCI) are performed each year to restore circulation to patients with blocked arteries.

In CABG, surgeons try to improve blood flow to the heart muscle by using a healthy artery or vein from another part of the body to bypass a blocked coronary artery.

PCI is a less invasive procedure in which blocked arteries are opened from the inside with a balloon. A stent, or small mesh tube, is then usually inserted to prop the opened arteries so that blood continues to flow into the heart muscle. The type of stent used in the study, called drug-eluting, is coated with medicine that is slowly and continuously released to prevent an opened artery from becoming blocked again.

The study, called "Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM)," involved 140 international centers and a total of 1,900 adults enrolled from 2005 to 2010. The participants had diabetes and coronary heart disease that involved narrowing of multiple blood vessels, but not the left main coronary artery, which usually requires immediate treatment with CABG.

At each clinical site, a team of specialists in neurology, heart disease, diabetes, and general medicine screened potential participants to ensure that they were eligible for both CABG and PCI. Those who were selected for the trial were randomly assigned to receive one of the interventions. As recommended by international guidelines for patients who receive drug-eluting stents, the PCI group also received anti-clotting therapies. A drug called abciximab was administered intravenously during the procedure, and clopidogrel was given orally for at least 12 months after the procedure, accompanied by aspirin for those who could tolerate it. Study participants were followed for at least two years.

During the trial, participants received standard medical care for all major cardiovascular risk factors such as high LDL cholesterol, high blood pressure, and high blood sugar. Participants also were counseled about lifestyle choices such as smoking cessation, diet, and regular exercise.

After five years, the CABG group had a lower combined rate of strokes, heart attacks, and deaths (18.7 percent) than the PCI group (26.6 percent). Strokes, which are a well-known risk of bypass surgery, occurred slightly more often in the CABG group (5.2 percent) than in the PCI group (2.4 percent). However, more people died from any cause in the PCI group (16.3 percent) than in the CABG group (10.9 percent). The survival advantage of CABG over PCI was consistent regardless of race, gender, number of blocked vessels, or disease severity.

"The advantages of CABG over PCI were striking in this trial and could change treatment recommendations for thousands of individuals with diabetes and heart disease," said Fuster.


Story Source:

The above story is based on materials provided by NIH/National Heart, Lung and Blood Institute. Note: Materials may be edited for content and length.


Journal Reference:

  1. Michael E. Farkouh, Michael Domanski, Lynn A. Sleeper, Flora S. Siami, George Dangas, Michael Mack, May Yang, David J. Cohen, Yves Rosenberg, Scott D. Solomon, Akshay S. Desai, Bernard J. Gersh, Elizabeth A. Magnuson, Alexandra Lansky, Robin Boineau, Jesse Weinberger, Krishnan Ramanathan, J. Eduardo Sousa, Jamie Rankin, Balram Bhargava, John Buse, Whady Hueb, Craig R. Smith, Victoria Muratov, Sameer Bansilal, Spencer King, Michel Bertrand, Valentin Fuster. Strategies for Multivessel Revascularization in Patients with Diabetes. New England Journal of Medicine, 2012; 121106104153000 DOI: 10.1056/NEJMoa1211585

Cite This Page:

NIH/National Heart, Lung and Blood Institute. "Cardiac bypass surgery superior to non-surgical procedure for adults with diabetes and heart disease." ScienceDaily. ScienceDaily, 4 November 2012. <www.sciencedaily.com/releases/2012/11/121104210847.htm>.
NIH/National Heart, Lung and Blood Institute. (2012, November 4). Cardiac bypass surgery superior to non-surgical procedure for adults with diabetes and heart disease. ScienceDaily. Retrieved October 21, 2014 from www.sciencedaily.com/releases/2012/11/121104210847.htm
NIH/National Heart, Lung and Blood Institute. "Cardiac bypass surgery superior to non-surgical procedure for adults with diabetes and heart disease." ScienceDaily. www.sciencedaily.com/releases/2012/11/121104210847.htm (accessed October 21, 2014).

Share This



More Health & Medicine News

Tuesday, October 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

How Nigeria Beat Its Ebola Outbreak

How Nigeria Beat Its Ebola Outbreak

Newsy (Oct. 20, 2014) The World Health Organization has declared Nigeria free of Ebola. Health experts credit a bit of luck and the government's initial response. Video provided by Newsy
Powered by NewsLook.com
Another Study Suggests Viagra Is Good For The Heart

Another Study Suggests Viagra Is Good For The Heart

Newsy (Oct. 20, 2014) An ingredient in erectile-dysfunction medications such as Viagra could improve heart function. Perhaps not surprising, given Viagra's history. Video provided by Newsy
Powered by NewsLook.com
Ebola Worries End for Dozens on U.S. Watch Lists

Ebola Worries End for Dozens on U.S. Watch Lists

Reuters - US Online Video (Oct. 20, 2014) Forty-three people who had contact with Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., were cleared overnight of twice-daily monitoring after 21 days of showing no symptoms. Rough Cut (no reporter narration). Video provided by Reuters
Powered by NewsLook.com
CDC Calls for New Ebola Safety Guidelines

CDC Calls for New Ebola Safety Guidelines

AP (Oct. 20, 2014) Centers for Disease Control and Prevention Director Dr. Tom Frieden laid out new guidelines for health care workers when dealing with the deadly Ebola virus including new precautions when taking off personal protective equipment. (Oct. 20) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

More Coverage


Bypass Surgery Improves Survival for Patients With Diabetes and Multi-Vessel Coronary Artery Disease

Nov. 5, 2012 An international, clinical research trial has shown that patients with diabetes whose multi-vessel coronary artery disease is treated with bypass surgery live longer and are less likely to suffer ... read more

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins