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 Presenter report:
Kapur, Akhil (United Kingdom)
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| The CARDia trial (Coronary Artery Revascularisation in Diabetes – 510 patients) is the largest randomised trial specifically comparing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease to date. The BARI trial (which recruited patients from 1987 to 1991) had a subset of 353 diabetic patients and suggested that CABG patients had improved survival compared to angioplasty, a finding which has guided practice since then. |
Preliminary results of the CARDia trial at one year show no apparent difference between CABG and PCI in terms of the composite endpoints of death, non fatal MI and non fatal stroke (10.2% vs. 11.6%, p=0.63). Comparison of the individual endpoints of CABG vs. PCI were as follows: death (3.3% vs. 3.2%, p=0.83), non fatal MI (5.7% vs. 8.4%, p= 0.25) and non fatal stroke (2.5% vs. 0.4%, p=0.09). Repeat revascularisation was higher in the PCI group as expected with a rate of 9.9% vs. 2.0% for CABG. Comparing CABG and a subgroup of 179 PCI patients who received drug eluting Cypher stents rather than bare metal stents, the composite endpoint of death, non fatal MI and non fatal stroke was 10.2% vs. 10.1% (p=0.98) again showing no difference in this composite endpoint.
CARDia shows that at 1 year, there is no apparent difference between CABG and PCI in terms of death or the composite of death, non fatal MI and non fatal stroke and suggests that PCI is a safe alternative to CABG in selected patients with diabetes and multi-vessel coronary artery disease. “We are very excited about these results. For the first time we have evidence from a randomised trial using modern treatments that PCI may offer safe coronary revascularisation in diabetic patients compared to surgery.” said Akhil Kapur, Study Director and presenter at the hotline clinical trials session at the ESC Congress in Munich on September 1st 2008.
Discussant: Fuster Valentin (United States of America)