For millions of people, angioplasty — a technique for widening blood vessels with the insertion of stents — can open clogged coronary arteries without having to resort to open-heart surgery. But new research suggests that this is not necessarily the best practice for people with diabetes.
The study, published in the New England Journal of Medicine, divided 1,900 people with diabetes and multiple clogged arteries into two groups. About half underwent bypass surgeryand the other half underwent angioplasty.
After five years, 18.7 percent of the bypass patients had either died or suffered a heart attack or stroke, compared with 26.6 percent of those who underwent angioplasty. That represents a 30 percent reduced risk for bypass surgery over angioplasty.
The study also found that the patients who underwent bypass had less than half the number of heart attacks (6 percent vs. 13.9 percent). They did have a higher rate of strokes within 30 days of surgery (5.2 percent vs. 2.4 percent), but their long-term risk of stroke was lower.
The first government advisory recommending bypass surgery over angioplasty for people with diabetes was issued 17 years ago, but doctors had sometimes ignored or discounted it. This research was intended to settle the issue.
No one wants to undergo open- heart surgery, says Dr. Chauncey Crandall,- if they think they can get the same results through angioplasty. But this study shows that if you are a diabetic with heart disease and your cardiologist recommends angioplasty, it might be wise to seek a second opinion.