Our Summary

This research paper reviews studies comparing two heart procedures - Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) - in patients with diabetes. Diabetes increases the risk of heart disease, and about 75% of patients with diabetes die from heart disease. Past studies have shown that CABG is better than PCI in treating heart disease in diabetics.

The researchers looked at studies published between January 1, 2015, and April 15, 2021. They reviewed 1,552 studies and included 25 in their review. They found that diabetic patients who had CABG had a lower risk of death within five years, fewer serious heart and brain events, fewer heart attacks, and fewer needed additional heart procedures. However, those who had PCI had a lower risk of stroke.

The research reaffirms that CABG is better than PCI for treating heart disease in diabetics. However, the gap between the two has decreased with the development of newer types of PCI, called 1st and 2nd generation Drug-Eluting Stents (DES). More research with long-term follow-up is needed to confirm which procedure is best for diabetics.

FAQs

  1. What were the key findings of the studies comparing CABG and PCI in patients with diabetes?
  2. Is CABG or PCI considered more effective in treating heart disease in diabetic patients?
  3. How has the development of 1st and 2nd generation Drug-Eluting Stents (DES) influenced the comparison between CABG and PCI?

Doctor’s Tip

A helpful tip a doctor might tell a patient about CABG is to follow a healthy lifestyle after the procedure, including maintaining a balanced diet, regular exercise, quitting smoking, and managing stress. These lifestyle changes can help improve the long-term success of the CABG procedure and reduce the risk of future heart issues.

Suitable For

Patients who are typically recommended CABG include:

  1. Diabetic patients with severe coronary artery disease: The research paper specifically focused on diabetic patients, as they have an increased risk of heart disease and tend to have more complex coronary artery disease compared to non-diabetic patients.

  2. Patients with multi-vessel disease: CABG is often recommended for patients with blockages in multiple coronary arteries, as it allows for bypassing the blocked arteries with healthy blood vessels from other parts of the body.

  3. Patients with left main coronary artery disease: CABG is considered the standard of care for patients with significant blockages in the left main coronary artery, as it provides better long-term outcomes compared to PCI.

  4. Patients with reduced heart function: CABG may be recommended for patients with reduced heart function (low ejection fraction) as it has been shown to improve overall survival and reduce the risk of future heart events.

  5. Patients who have failed previous PCI: In cases where PCI has been unsuccessful or has resulted in restenosis (re-narrowing of the treated artery), CABG may be recommended as a more durable treatment option.

Overall, CABG is typically recommended for patients with more complex coronary artery disease, especially those with diabetes, multi-vessel disease, left main disease, reduced heart function, or previous failed PCI. It is important for patients to discuss their individual case with their healthcare provider to determine the most appropriate treatment option.

Timeline

Before CABG:

  • Patient is diagnosed with coronary artery disease (CAD) and may experience symptoms such as chest pain, shortness of breath, and fatigue.
  • Patient undergoes diagnostic tests such as a coronary angiography to determine the extent of blockages in the coronary arteries.
  • Patient may undergo lifestyle changes, medications, and/or minimally invasive procedures such as PCI to manage the symptoms of CAD.

After CABG:

  • Patient undergoes pre-operative evaluations and preparations for surgery, including blood tests, imaging tests, and consultations with the surgical team.
  • Patient undergoes CABG surgery, during which the surgeon creates new pathways for blood to flow around the blocked arteries using blood vessels from other parts of the body.
  • Patient is monitored closely in the intensive care unit (ICU) immediately after surgery and then transferred to a regular hospital room for further recovery.
  • Patient undergoes cardiac rehabilitation to regain strength and improve cardiovascular health.
  • Patient may need to take medications to manage cholesterol, blood pressure, and prevent blood clots.
  • Patient is advised to make lifestyle changes such as maintaining a healthy diet, exercising regularly, quitting smoking, and managing stress to prevent further heart disease.

What to Ask Your Doctor

  1. What are the benefits of CABG compared to PCI for diabetic patients?
  2. What are the risks associated with CABG in diabetic patients?
  3. How long is the recovery time after CABG for diabetic patients?
  4. Are there any alternative treatment options to CABG for diabetic patients?
  5. What is the success rate of CABG in diabetic patients compared to PCI?
  6. How often will follow-up appointments be needed after undergoing CABG as a diabetic patient?
  7. Are there specific lifestyle changes or medications that are recommended for diabetic patients after CABG?
  8. What are the potential complications that diabetic patients should be aware of after undergoing CABG?
  9. How will my diabetes be managed during and after the CABG procedure?
  10. Are there any ongoing clinical trials or research studies related to CABG for diabetic patients that I should consider participating in?

Reference

Authors: El-Andari R, Bozso SJ, Fialka NM, Kang JJH, Nagendran J, Nagendran J. Journal: Ann Surg. 2022 Jun 1;275(6):1058-1066. doi: 10.1097/SLA.0000000000005391. Epub 2022 Jan 25. PMID: 35081569