Bypass Better for Diabetics With Heart Disease

Older diabetics with more than one blocked artery were much less likely to die within five years or have another heart attack if they chose bypass surgery instead of stents to treat their condition, a major new study found.

Researchers said the five-year study of 1,900 patients (average age: 63) with diabetes found that those who underwent bypass surgery to improve blood flow to the heart were 30 percent less likely to die or suffer a heart attack than were those who opted for the less-invasive treatment of propping open arteries with a stent, according to the American Heart Association.

The study, funded by the National Institutes of Health, was presented at the heart association’s scientific meeting Saturday.

“The advantages were striking in this trial and could change treatment recommendations for thousands of individuals with diabetes and heart disease,” said lead researcher Valentin Fuster, M.D., of the Mount Sinai School of Medicine in New York, Reuters reported.

Not only was the death rate from any cause lower in the bypass group, there were also twice as many heart attacks among diabetics in the stent group within five years – 99 versus 48 – which Fuster called “very significant.”

Previous studies of diabetic heart patients had shown that a bypass procedure, in which healthy vessels from another part of the body are patched onto the heart to bypass the diseased ones, was superior to implanting bare metal stents, tiny tubes that hold arteries open after they’ve been cleared. Researchers, however, thought that newer stents, which are coated with drugs to prevent blockage from recurring, might do better. But after five years, the bypass group had a lower combined rate of heart attack, stroke or death, 19 percent, compared with 27 percent for the stent group.

The study addresses a long-running debate over which option is more beneficial for diabetics, whose condition typically makes diseased coronary arteries more complex and difficult to treat, the Wall Street Journal reported. In the U.S., 1 million patients undergo bypass or stenting procedures annually and 25 to 30 percent involve diabetics with multiple diseased arteries, researchers said.

Researchers did find that while those undergoing bypass surgery had fewer deaths and heart attacks, they did have slightly more strokes – 5.2 percent versus 2.4 percent – not enough to negate the significant benefits of fewer deaths and heart attacks, Fuster said.

In the trial, 29 percent of the patients were female; the majority of subjects, 83 percent, had coronary disease in three arteries.

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Photo: qthomasbower via flickr