Percutaneous Coronary Intervention May be Peferable in Diabetic Patients With Prior CABG

In diabetic patients who require a revascularization procedure following previous coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) may be preferable to repeat CABG, researchers report in the December 4th issue of the Journal of the American College of Cardiology.

Dr. William S. Weintraub of Emory University, Atlanta, and colleagues observe that the longevity of patients has increased as CABG care has improved. However, this has also led to the likelihood of a need for repeat coronary interventions, and this is particularly so in diabetic patients who at greater risk of long-term problems after CABG.

To determine whether repeat CABG or PCI might be preferable in such circumstances, the researchers examined data on more than 1700 diabetics who had had prior CABG.

In all, 1123 had undergone PCI and 598 had had repeat CABG. Both groups were similar in respect to age, duration of diabetes and other factors and 10-year mortality following PCI (68%) was not significantly different from that of CABG (74%).

However, despite the fact that “the data on long-term mortality provide no support for one method of revascularization over the other,” the researchers point out that the in-hospital mortality rate for repeat CABG was 11.2% and that for PCI was 1.61%.

In light of these findings, they conclude that “PCI should be strongly considered in all patients for whom there is a percutaneous alternative.”

Am J Coll Cardiol 2002;40:1968-1705.