Abstract 2990: Comparison of Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft Surgery (CABG) in Diabetic Patients (pts) with Multi-Vessel Coronary Artery Disease in The Bare-Metal Stent (BMS) Era: From The Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto)
Background: Although randomized trials indicate diabetic pts treated with PCI using BMS had a worse survival outcome than pts assigned to CABG, they exclude high-risk pts. The use of drug-eluting stents (DES) has led to dramatic reductions in restenosis in diabetic pts. However, DES appear to increase the risk for late thrombosis. It is important to evaluate survival outcome of PCI using BMS in diabetic pts in real world.
Methods: CREDO-Kyoto is a registry of Japanese who underwent first elective PCI or CABG between January 2000 and December 2002. Total 9877 pts from 30 institutions were available. This study consists of 1975 (PCI; 1266, CABG; 709) multivessel diabetic pts. The left main trunk disease and pts>75years old were excluded.
Results: LITA grafts were used in 94.1%. Stents (BMS only) were used in 83.7%. The follow up period was 1262±504 days. Until hospital discharge, CABG-pts had a higher incidence of any-cause death and cerebrovascular accident (CVA) than PCI-pts (PCI vs. CABG; death; 0.7% vs. 1.8%, p<0.03, CVA; 0.4% vs. 1.6%, p<0.01).There was no significant difference in the rate of free from any-cause death, CVA and combined events (death, MI or CVA) between PCI-pts and CABG-pts (PCI vs. CABG at 3 years; death; 90.6% vs. 91.6%, CVA; 95.7% vs. 93.4%, combined events; 83.1% vs. 84.2%). The rate of free from MI and revascularization were higher in CABG-pts than PCI-pts (PCI vs. CABG at 3years; MI; 94.3% vs. 97.1%, p=0.007, revascularization; 44.2% vs. 90.4%, p<0.0001). By multivariate analysis including factors associated with all-cause mortality by univariate analysis, independent predictors of all-cause death were as follows; R.R. (95% C.I.); renal dysfunction (serum creatinin >1.5mg/dl): 3.75 (2.50 –5.63), p<0.00001, age>65 years old: 1.81 (1.28 –2.58), p=0.0007, malignancy: 2.04(1.26 –3.17), p=0.005, anti-platelet therapy: 0.45 (0.28 – 0.78), p=0.006, statins use: 0.62 (0.38 – 0.97), p=0.04, anemia (Hb<12mg/dl): 1.48 (1.00 –2.18), p<0.05.
Conclusions: In multivessel diabetic pts, PCI in the era of BMS yields an equivalent long-term survival outcome compared with CABG. The strategy of PCI is associated with higher incidence of MI and repeat revascularization. Statins use and anti-platelet therapy are associated with improved survival.