In another study in today's Circulation, investigators at 18 centers in the United States compared survival among diabetic patients given either bypass surgery or balloon angioplasty and found a "striking" four-times-lower death rate among bypass patients. The survival advantage appears to be limited to those whose hearts were replumbed with arteries from their own chest wall.
During a more than 5-year follow-up, the cardiac death rate from heart disease in diabetics who had bypass surgery was 5.8 percent, vs. 20.6 percent for diabetics whose vessels were reopened with a balloon. Among the bypass patients, heart disease deaths were only 2.9 percent when at least one internal chest artery was used, compared to 18.2 percent in patients getting grafts from their leg veins. Internal chest grafts were found to be particularly protective for patients suffering heart attacks during follow-up.
In an editorial, Stephen G. Ellis, M.D., and Craig R. Narins, M.D. of the Cleveland Clinic, which participated in the study, noted the relatively small numbers of patients in various groups investigated and reported that any conclusions based on the results be approached "with caution." The new report by the study chairman, Robert L. Frye, M.D., coordinating the study from the University of Pittsburgh, and his colleagues, elaborated on an earlier study of 1,829 patients in the BARI (Bypass Angioplasty Revascularization Investigation) trial. Of those, 353 were diabetic. That earlier report found no overall difference in five-year survival, except in diabetics who had "significantly better" survival after bypass than after angioplasty.
Contact: Robert L. Frye, M.D. can be reached by calling the University of Pittsburgh, Pa.: (412) 624-3729.