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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAt 1 year following intervention, there apparently is no difference between coronary artery bypass grafting and percutaneous coronary intervention in treating diabetic patients with multivessel disease, as measured by the incidence of a composite of death, myocardial infarction, and stroke. These results are part of the Coronary Artery Revascularization in Diabetes [CARDia; \u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN19872154\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN19872154\u003C\/a\u003E] trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EAt 1 year following intervention, there apparently is no difference between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in treating diabetic patients with multivessel disease, as measured by the incidence of a composite of death, myocardial infarction (MI), and stroke.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe CARDia (Coronary Artery Revascularization in Diabetes Trial; \u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN19872154\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN19872154\u003C\/a\u003E) trial results were presented in Munich at the 2008 European Society of Cardiology Congress by Akhil Kapur, MD, London Chest Hospital, Barts and the London NHS Trust, London, UK.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003E\u201cWe saw more repeat revascularization in the PCI group, but with similarity in other major outcomes at 1 year, we can now consider PCI a reasonable strategy in diabetic patients with multivessel disease. But longer follow-up is still needed,\u201d said Dr. Kapur.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDr. Kapur emphasized that even though the trial was designed to test the hypothesis that PCI is noninferior to CABG (n=254) in these patients, the targeted enrollment of 600 subjects was not met, and the noninferiority of PCI could not be formally, statistically established by the outcome of the trial. \u201cThe trial was, finally, underpowered to test this endpoint,\u201d he said. Noninferiority trials are intended to show that the effect of one treatment, in this case PCI, is not worse than that of an active control, in this case CABG, by a statistically significant margin. Investigators randomized 510 diabetic patients (mean age 64 years, 74% men, average weight 84 kg) with multivessel disease to CABG (n=254) or PCI (n=256). Nearly one-quarter of the admissions were considered acute (23.7% CABG group vs 21.5% in the PCI cohort). Similar numbers of patients required insulin to treat diabetes (31.4% of CABG vs 30.6% of PCI). All patients in the PCI group were treated with aspirin, clopidogrel, and GP IIb\/IIIa inhibitors.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EOf the CABG group, 229 underwent the procedure. Of the PCI group, 252 underwent the procedure. There was 96% (n=245) subject follow-up at 1 year in the CABG group and 98% (n=251) in the PCI group.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe investigators reported that for the composite primary endpoint of death, MI, and stroke at 1 year, there was a rate of 10.2% for CABG veruss 11.6% for PCI (OR=1.15, 95% CI, 0.65\u20132.03; p=0.63). This result was not statistically significant enough to establish the noninferiority of PCI.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe rate for revascularization at 1 year was 2.0% for CABG versus 9.9% for PCI (OR=5.31, 95% CI, 2.00\u201314.11; p=0.001).\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThe rate of death at 1 year was 3.3% for CABG versus 3.2% for PCI (OR=0.98, 95% CI, 0.36\u20132.64; p=0.83). The rate of nonfatal MI was 5.7% for CABG versus 8.4% for PCI (OR=1.51, 95% CI, 0.75\u20133.03; p=0.25). The rate of nonfatal stroke was 2.5% for CABG versus 0.4% for PCI (OR=0.16, 95% CI, 0.02\u20131.33; p=0.09). The composite outcome of death, MI, stroke, and repeat revascularization was 11% for CABG versus 17.5% for PCI (OR=1.72, 95% CI, 1.02\u20132.87; p=0.04).\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EFor CABG (n=245) versus the PCI-DES (n=179; 71% of total) subgroup, the primary composite outcome of death, nonfatal MI, and nonfatal stroke at 1 year was 10.2% for CABG versus 10.1% for PCI-DES (p=0.98). The rate for revascularization at 1 year was 2.0% for CABG versus 7.3% for PCI-DES (p=0.013). The rate of death at 1 year was 3.3% for CABG versus 3.9% for PCI-DES (p=0.723). The rate of nonfatal MI was 5.7% for CABG versus 6.2% for PCI-DES (p=0.852). The rate of nonfatal stroke was 2.5% for CABG versus 0% for PCI-DES (p=0.041). The composite outcome of death, nonfatal MI, nonfatal stroke, and repeat revascularization at 1 year was 11% for CABG versus 15.1% for PCI-DES (p=0.217).\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EDr. Kapur noted that the findings are preliminary and that several clinical events still need to be adjudicated.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/6\/19.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmd0d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}