(Circulation. 1997;96:2551-2556.)
© 1997 American Heart Association, Inc.
Articles |
Relationship Between Diabetes Mellitus and Long-term Survival After Coronary Bypass and Angioplasty
From the Duke Heart Center, Duke University Medical Center, Durham, NC.
Correspondence to Gregory W. Barsness, MD, Duke Clinical Research Institute, 2024 W Main St, Durham, NC 27705. E-mail barsn001{at}onyx.mc.duke.edu
Background Recent subgroup analyses of randomized trials have suggested that percutaneous intervention in diabetic patients with multivessel disease results in higher mortality than coronary artery bypass graft surgery (CABG). We studied the relationship between diabetes and survival after revascularization in a large prospective cohort of patients with multivessel coronary artery disease.
Methods and Results By analyzing data for 3220 patients
(24% diabetic) with symptomatic two- or three-vessel
coronary disease who were undergoing
percutaneous transluminal coronary angioplasty
(PTCA) or CABG at Duke University Medical Center between 1984 and 1990,
we found that at 5 years, unadjusted survival in the group of patients
undergoing CABG was 74% in diabetics and 86% in nondiabetics.
Similarly, 5-year survival among PTCA patients was 76% in diabetics
and 88% in patients without diabetes. After adjustment for baseline
characteristics, diabetic patients receiving either PTCA or CABG had
significantly poorer survival than nondiabetics
(
2=43.56, P<.0001). Unlike previous
studies, however, there was no significant differential effect of
diabetes on outcome between patients treated with PTCA and those
treated with CABG (2=0.01, P=.91).
Conclusions Although diabetes was associated with a worse long-term outcome after both PTCA and CABG in patients with multivessel coronary artery disease, the effect of diabetes on prognosis was similar in both treatment groups. Thus, our findings support the concept that the choice of initial revascularization strategy should not be based exclusively on a history of diabetes but rather should rely on other factors, such as angiographic suitability and clinical status.
Key Words: diabetes mellitus • angioplasty • bypass • survival
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