Abstract 2119: Five-Year Angiographic Follow-Up in Diabetic and Nondiabetic Patients Associated with Progression of Coronary Disease: Medical, Angioplasty or Surgery Study (MASS II)
Introduction: Clinical and epidemiologic studies have shown an increased risk of coronary artery disease (CAD) among patients with diabetes mellitus (DM). Angiographic progression of coronary atherosclerosis is frequently observed in clinical practice and is used as an end-point in clinical trials; however, its prognostic significance is unclear. In this study, we analyzed the significance of progression in diabetic and nondiabetic patients.
Methods: Initial and 5-year follow-up angiograms were obtained in 392 randomized patients. Progression was defined as an increase in diameter of stenosis by >15% of at least one coronary lesion. We sought to evaluate the coronary disease progression in the medical, surgical, and angioplasty groups in the LAD, LCX, and RCA arteries in diabetic (136) and nondiabetic patients (256). Also, we analyzed the relation of the rate of progression with morbidity and need for an additional intervention.
Results: A total of 392 patients randomly assigned to either CABG (n=136), PCI (n=146), or medical treatment (n=110) were analyzed. No significant differences existed between the groups related to age, sex, hypertension, smoking, or lipid disorders. We did not observe any difference in terms of CAD progression when we compared diabetic with nondiabetic patients. When we stratified by type of treatment, the surgery group had less progression in both diabetic (P=0.014) and nondiabetic groups (P=0.007). In the PCI group, we observed more progression in RCA and LAD territories compared with that in nondiabetic patients (P<0.05). No relation was found between progression and the rate of events in both groups.
Conclusion: Diabetes was not associated with greater progression of CAD in patients with stable CAD and preserved ventricular function during 5-years of follow-up. However, the diabetic patients who underwent CABG had less progression of CAD compared with patients in the PCI and MT groups.