Editorial by Dr. Kurlansky Sheds Light on Risks of Heart Procedures in Patients with Diabetes
CABG better than Interventional Procedures for Patients with Diabetes
Patients with diabetes face a host of associated health problems including heart disease, kidney disease, nerve damage, and many others. As the prevalence of diabetes has skyrocketed, so too has the need to treat coronary artery disease: in just four decades, surgery to treat blocked coronary arteries in patients with diabetes has spiked five-fold (from 7% to 37%). This trend carries enormous implications, as a press release from the American Association for Thoracic Surgery (AATS) explains. “These patients have more postoperative complications and decreased long-term survival than those without diabetes, and represent a growing challenge to reining in healthcare costs.” Compared to non-diabetics, people with diabetes who undergo surgery for coronary artery disease have more in-hospital deaths (2.0% vs. 1.3%), deep sternal wound infections (2.3% vs. 1.2%), strokes (2.2% vs. 1.4%), renal failure (4.0% vs. 1.3%), and longer postoperative hospital stays (9.6% vs. 6.0%). Overall survival rates are significantly worse among diabetics at 1, 5, 10, and 20 years (20-year survival was 18% for patients with diabetes, compared to 42% among non-diabetics).
Interventional procedures such as angioplasty and hybrid, endovascular procedures can provide less invasive alternatives to coronary artery bypass grafting (CABG). However diabetic patients ultimately fare better with CABG, explains Paul Kurlansky, MD, Associate Director, Center for Innovation and Outcomes Research at NewYork-Presbyterian/Columbia University Medical Center. His editorial commentary, Diabetes: To graft or not to graft is no longer the question, was published together with three other papers in the August edition of the Journal of Cardiac and Thoracic Surgery to address the trends associated with the rise in diabetic patients undergoing surgery for coronary artery disease.
Evidence shows that among patients with diabetes, coronary artery bypass grafting offers better long-term outcomes than interventional procedures. Dr. Kurlansky says this is due in large part to the aggressive, systemic nature of vascular disease caused by diabetes. “Interventional procedures treat specific lesions, whereas CABG tends to address downstream circulation,” he writes. “We do not see the impacts of diabetes immediately after surgery, but rather its effects take an increasing toll over time, in the form of greater complications and shorter life-span.”
Dr. Kurlansky cautions that cost analysis of treatment options must take into account “the costs associated with the need for additional medical care, reintervention, longevity, and quality of life.” With no indication that the rate of diabetes and coronary artery disease will slow down any time soon, there will be plenty of opportunity for further research