The best approach to multivessel revascularization in diabetics: Is the debate finally settled?

The latest results, as summarized by Mark Hlatky in a NEJM editorial:

After 5 years of follow-up, the 947 patients assigned to undergo CABG had significantly lower mortality (10.9% vs. 16.3%) and fewer myocardial infarctions (6.0% vs. 13.9%) than the 953 patients assigned to undergo PCI. However, patients in the CABG group had significantly more strokes (5.2% vs. 2.4%), mostly because of strokes that occurred within 30 days after revascularization. In the CABG group, the primary composite outcome of death, myocardial infarction, or stroke over 5 years was reduced by 7.9 percentage points, or a relative decrease of 30%, as compared with PCI (18.7% vs. 26.6%, P=0.005). These results are consistent with the findings of multiple previous trials comparing CABG and PCI in patients with diabetes, as well as the most recent trials in which drug-eluting stents were used during PCI.

The editorial is worth reading in full. The study it describes is here. Both are ungated.

(I really do think that anyone interested in health policy should try to learn enough medical science to appreciate this debate and those like it in other clinical areas. Click through, read, ask questions. This post may also help. This book may help too.)

UPDATE: Given I’m at work, which confers some access, I may not be the best judge as to whether the papers are ungated.



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