Randomized Comparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Diabetic Patients

Abstract

The CARDia (Coronary Artery Revascularization in Diabetes) trial is the first randomized trial of coronary revascularization in diabetic patients, but the 1-year results did not show that PCI is noninferior to CABG. However, the CARDia trial did show that multivessel PCI is feasible in patients with diabetes, but longer-term follow-up and data from other trials will be needed to provide a more precise comparison of the efficacy of these 2 revascularization strategies. (The Coronary Artery Revascularisation in Diabetes trial; ISRCTN19872154).

Influence of Diabetes Mellitus on Long-Term Outcomes of Patients With Unprotected Left Main Coronary Artery Disease Treated With Either Drug-Eluting Stents or Coronary Artery Bypass Grafting

“…Trials including the Arterial Revascularization Therapies Study (ARTS), 23) the Coronary Artery Revascularization in Diabetes (CARDia) study, 24) and a subgroup analysis of the Synergy between PCI with TAXUS and Cardiac Surgery (SYNTAX) study, 11) have reported no difference in mortality but a greater need for repeat revascularization with PCI in patients with diabetes. In the Bypass Angioplasty Revascularization Investigation (BARI) trial, 14) patients with diabetes and multivessel disease who underwent CABG lived longer than did patients undergoing balloon angioplasty.…”

Guidelines on myocardial revascularization

“…Though admittedly underpowered, the CARDia trial [114] is the only trial reported to date that was specifically designed to compare PCI using BMS (31%) or DES (69%) with CABG in diabetic patients. At 1 year, the combined incidence of death, MI, or stroke was 10.5% in the CABG arm and 13.0% in the PCI arm (HR 1.25, 95% CI 0.75 2.09).…”

Almanac 2011: stable coronary artery disease. The national society journals present selected research that has driven recent advances in clinical cardiology

“…64 In CARDia, 510 patients with diabetes, 93% of whom had multivessel disease, were randomised to PCI or CABG. 65 The composite rate of all-cause mortality, non-fatal MI, and non-fatal stroke at 1 year was 13.0% for PCI and 10.5% for CABG; this difference was not statistically significant but the study was powered and non-inferiority for PCI compared with CABG was not confirmed. It is the BARI-2D findings, therefore, that generated greater interest by showing that contemporary medical treatment of diabetic patients with complex coronary artery disease compares favourably with revascularisation.…”