Recent research has found lower death rates and fewer heart attacks
in people with diabetes who've undergone the open-heart procedure
known as a coronary artery bypass graft (CABG), compared to those who
had the less-invasive coronary angioplasty with stents. Angioplasty is
also called percutaneous coronary intervention (PCI).
Now a new study of the same group of patients reports that they
also have a better quality of life after the more-invasive bypass
procedure. http://bookmarkinghub.com/story.php?title=customized-fat-loss-2
"Recovery and early quality of life was better immediately with
PCI, which is not surprising given the much less invasive nature of
that procedure. But, between six months and two years, there was less
[chest pain], slightly better physical performance and quality of life
with CABG," said senior study author David Cohen, M.D., director of
cardiovascular research at St. Luke's Mid America Heart Institute, in
Kansas City, Mo.
Results of the study were published in the Journal of the American Medical Association.
Angioplasty is a common procedure to open up blocked blood vessels
that supply blood to the heart. A special balloon-tipped catheter is
inserted into a blood vessel (usually in the leg), and then threaded up
to the area around the heart. If a blockage is encountered, it can be
opened by inflating the balloon. To keep the blood vessel open, doctors
often insert a small lattice-like tube (stent) into the blood vessel,
the American Heart Association explains. http://bookmarkednews.com/story.php?title=truth-about-cellulite-2
In coronary artery bypass graft surgery, a surgeon takes blood
vessels from other parts of the body and uses these to reroute blood
flow around the blocked blood vessel. While this surgery is very
effective, it is more invasive than angioplasty and requires more
recovery time both in and out of the hospital.
Several previous studies have shown that bypass surgery is
generally the preferred procedure for people with diabetes. Dr. Cohen
said there are a number of reasons why the more-invasive procedure is
better.
"People with diabetes tend to have different anatomy and more co-morbidities [other existing health conditions]. Their blood vessels tend to be smaller; they have more peripheral vascular disease and more renal [kidney] failure, which are things known to be bad for those undergoing PCI," he pointed out.
"People with diabetes tend to have different anatomy and more co-morbidities [other existing health conditions]. Their blood vessels tend to be smaller; they have more peripheral vascular disease and more renal [kidney] failure, which are things known to be bad for those undergoing PCI," he pointed out.
A diabetes expert explained why the less-invasive treatment isn't necessarily the best option.
"PCI tends to fix only a little bit at a time, but people with
diabetes have very diffuse disease," said Joel Zonszein, M.D., director
of the clinical diabetes center at Montefiore Medical Center in New
York City. "It's usually not one single blood vessel, it's all over.
And, you don't see the full obstruction, but if you look at the blood
vessels, they're quite diseased, which is probably part of the
inflammatory process. The disease process is different in people with
diabetes, and that's why the more aggressive treatment works better."
Although previous studies have found that bypass surgery is often
the better choice for people with diabetes, Dr. Cohen and his
colleagues felt that because of the improvements in angioplasty and
stents, it was time to compare the procedures again. http://v80.me/search.php?search=http://health.proconview.com/
The investigators recruited 1,900 people with diabetes from 18
countries to participate in the study. Most had type 2 diabetes, and all
had known problems in more than one blood vessel. The average age was
63 years, and 72 percent of patients were male.
Study volunteers were randomly assigned to receive either bypass
surgery or angioplasty as their initial treatment between 2005 and 2010.
Participants completed questionnaires to evaluate their levels of
chest pain (angina), physical limitations and quality of life at the
start of the study, one month, six months, 12 months and annually
thereafter.
Dr. Cohen said that in previously reported results from this trial,
there were lower rates of death and fewer heart attacks in the bypass
surgery group. The risk of stroke was higher in this group, he noted.
However, Dr. Cohen added that the overall rate of stroke was small
after five years with either treatment.
Between six months and two years after the initial treatment, those
who had a coronary artery bypass graft reported less chest pain, fewer
physical limitations and better quality of life, according to the
study. After two years, no significant differences existed between the
two groups with regard to these patient-reported outcomes.
"If people with diabetes have severe coronary artery disease with
symptoms, they should have a full discussion with their physician about
available revascularization procedures. Guidelines give a strong
preference to CABG, but treatment has to be individualized," Dr. Cohen
said.
Zonszein agreed that coronary artery bypass graft is usually "the
right procedure to do in patients with diabetes who have symptoms." He
added that this study also points out the importance of trying to
prevent vascular disease in the first place. Medications to lower
cholesterol, blood pressure and blood sugar are all important for people
with diabetes, he said.