title: Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial.
abstract: OBJECTIVE
  The purpose of this study was to compare the safety and efficacy of percutaneous coronary intervention (PCI) with stenting against coronary artery bypass grafting (CABG) in patients with diabetes and symptomatic multivessel coronary artery disease.
  
  
  BACKGROUND
  CABG is the established method of revascularization in patients with diabetes and multivessel coronary disease, but with advances in PCI, there is uncertainty whether CABG remains the preferred method of revascularization.
  
  
  METHODS
  The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), and stroke, and the main secondary outcome included the addition of repeat revascularization to the primary outcome events. A total of 510 diabetic patients with multivessel or complex single-vessel coronary disease from 24 centers were randomized to PCI plus stenting (and routine abciximab) or CABG. The primary comparison used a noninferiority method with the upper boundary of the 95% confidence interval (CI) not to exceed 1.3 to declare PCI noninferior. Bare-metal stents were used initially, but a switch to Cypher (sirolimus drug-eluting) stents (Cordis, Johnson & Johnson, Bridgewater, New Jersey) was made when these became available.
  
  
  RESULTS
  At 1 year of follow-up, the composite rate of death, MI, and stroke was 10.5% in the CABG group and 13.0% in the PCI group (hazard ratio [HR]: 1.25, 95% CI: 0.75 to 2.09; p=0.39), all-cause mortality rates were 3.2% and 3.2%, and the rates of death, MI, stroke, or repeat revascularization were 11.3% and 19.3% (HR: 1.77, 95% CI: 1.11 to 2.82; p=0.02), respectively. When the patients who underwent CABG were compared with the subset of patients who received drug-eluting stents (69% of patients), the primary outcome rates were 12.4% and 11.6% (HR: 0.93, 95% CI: 0.51 to 1.71; p=0.82), respectively.
  
  
  CONCLUSIONS
  The CARDia (Coronary Artery Revascularization in Diabetes) trial is the first randomized trial of coronary revascularization in diabetic patients, but the 1-year results did not show that PCI is noninferior to CABG. However, the CARDia trial did show that multivessel PCI is feasible in patients with diabetes, but longer-term follow-up and data from other trials will be needed to provide a more precise comparison of the efficacy of these 2 revascularization strategies. (The Coronary Artery Revascularisation in Diabetes trial; ISRCTN19872154).
authors.affiliation: London Chest Hospital, Barts and The London NHS Trust, Imperial College, London, England.
authors.forename: Akhil
authors.initials: A
authors.lastname: Kapur
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Hall
authors.forename: Iqbal S
authors.initials: IS
authors.lastname: Malik
authors.forename: Ayesha C
authors.initials: AC
authors.lastname: Qureshi
authors.forename: Jeremy
authors.initials: J
authors.lastname: Butts
authors.forename: Mark
authors.initials: M
authors.lastname: de Belder
authors.forename: Andreas
authors.initials: A
authors.lastname: Baumbach
authors.forename: Gianni
authors.initials: G
authors.lastname: Angelini
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.forename: Keith G
authors.initials: KG
authors.lastname: Oldroyd
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.forename: Michael
authors.initials: M
authors.lastname: Roughton
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
authors.forename: Jens Peder
authors.initials: JP
authors.lastname: Bagger
authors.forename: Kenneth
authors.initials: K
authors.lastname: Morgan
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Beatt
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D048909:Diabetes Complications / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged