Patients with both diabetes and
advanced blockages in at least three heart vessels will find good news in
new findings announced from the CARDia trial, says The Society for
Cardiovascular Angiography and Interventions (SCAI). The one-year findings
of the new study indicate that these patients can safely choose to undergo
angioplasty and stenting rather than open-heart surgery.
At the European Society of Cardiology Congress (Munich, Germany),
investigators from the United Kingdom presented the results of CARDia
(Coronary Artery Revascularization in Diabetes), a clinical trial comparing
percutaneous coronary intervention (PCI) vs. open-heart surgery in patients
typically considered to be poor candidates for angioplasty and stenting.
Since the combination of diabetes and multi-vessel coronary artery disease
has long been considered the domain of surgeons, their findings surprised
some: The patients who underwent PCI rather that surgery did just as well
as the surgery patients on the primary endpoint of death, heart attack, and
stroke. In addition, the PCI patients experienced fewer strokes and less
bleeding.
This finding differs from earlier trials comparing PCI and surgery in
these patients, perhaps because drug-eluting stents have been added to the
mix, suggest SCAI leaders. "The take-away message is that diabetic patients
with complex coronary artery disease may now be able to choose angioplasty
and stenting over bypass surgery," says Dr. Bonnie Weiner, SCAI Immediate
Past President, Professor of Medicine, and Director of Interventional
Cardiology Research at St. Vincent Hospital at Worcester Medical Center
(Worcester, MA). "It's important to realize that this is one trial and the
first-year findings, but it's a good sign for patients because it could
ultimately broaden their options."
CARDia also examined whether, after undergoing PCI or surgery, patients
required a repeat procedure. The difference in repeat revascularization
between PCI and bypass surgery was very small but statistically
significant, despite an unusually low rate for both groups (9.9% for PCI
vs. 2.0% for bypass; p=0.001). Further, when the patients who received
drug-eluting stents (rather than bare metal stents or the entire study
population) were specifically analyzed, the difference in revascularization
in the PCI group was even lower, and the difference in the rates of repeat
revascularization was less important (7.3% for PCI vs. 2.0% for bypass;
p=0.013). This represented about two-thirds of the study population and
more closely reflects current practices.
"When you compare only the patients who had angioplasty with
drug-eluting stents with the bypass surgery patients, you find very similar
repeat revascularization rates," says Dr. Weiner. "We'll want to see if
these findings continue as the follow-up proceeds since the surgery
patients are less likely to have repeat revascularization procedures this
early, but it's a very good sign for patients who are candidates for PCI
and prefer it because it is less invasive and easier to recover from than
surgery. In our view, this is very good news for patients because it gives
them more options for their care."
About SCAI
Headquartered in Washington, D.C., The Society for Cardiovascular
Angiography and Interventions is a 4,000-member professional organization
representing invasive and interventional cardiologists in more than 60
countries. SCAI's mission is to promote excellence in invasive and
interventional cardiovascular medicine through physician education and
representation, and advancement of quality standards to enhance patient
care. SCAI's annual meeting has become the leading venue for education,
discussion, and debate about the latest developments in this dynamic
medical specialty. SCAI's new patient and physician education program,
Seconds Count, offers comprehensive information about cardiovascular
disease. For more information about SCAI and Seconds Count, visit scai or seconds-count.
Society for Cardiovascular Angiography and Interventions (SCAI)
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