Bypass surgery beats angioplasty for diabetics

For diabetes patients with blockages in the coronary arteries, bypass surgery is better than angioplasty, according to the findings of a major new study that could change clinical practice.

Valentin Fuster, M.D., PhD, of the Mount Sinai School of Medicine in New York City, and colleagues analyzed data from 1,900 patients at 140 centers internationally who had diabetes and multivessel coronary artery disease. Those who had coronary artery bypass grafting in which a vein from another part of the body is used to detour around or bypass the blocked coronary artery had a 30 percent lower risk of death over five years than those who had percutaneous coronary intervention, also known as angioplasty, in which a balloon-like device is used to clear arteries.

The results of this trial known as the FREEDOM trial are presented in this week s New England Journal of Medicine.

"The results are clear," Fuster told reporters at the American Heart Association meeting in Los Angeles. "I think they are going to change practice."

Given the high prevalence of both diabetes and coronary heart disease the most common killer in the western world this is a highly important advance in the clinical approach to diabetics with heart disease, said ACSH s Dr. Gilbert Ross. Both types of intervention have high rates of success, but when dealing with hundreds of thousands of patients, an improved prognosis by even a few percent amounts to a major benefit.