Abstract 3587: Does Surgical Revascularization Provide A Survival Advantage In All Diabetic Patients With Acute Coronary Syndromes And Multivessel Coronary Artery Disease?
Background: Randomized clinical trials have suggested that CABG is superior to PCI in diabetic patients with multivessel coronary artery disease (MV CAD). However, these trials included patients with recent acute coronary syndromes (ACS) as well as stable CAD. The optimal revascularization strategy for ACS patients with diabetes and MV CAD remains a controversial topic in modern cardiological practice.
Objectives: The purpose of this study was to examine the long-term survival of a large cohort of ACS patients with diabetes and MV CAD according to revascularization strategy (CABG vs. PCI).
Methods: A total of 1140 diabetic patients hospitalized with an ACS and MV CAD between January 1998 and December 2000 were identified using two databases (APPROACH-Alberta; ICONS-Nova Scotia). The primary study end-point was 5-year survival from index catheterization for each of the revascularization groups stratified according to coronary anatomy (2- and 3-vessel CAD).
Results: The crude 5-year survival of diabetics with ACS and 2- and 3-vessel CAD is shown graphically. Risk-adjusted hazard ratio analysis comparing cumulative 5-year survival of diabetics with 3-vessel CAD suggests a survival benefit for CABG versus PCI (HR 0.70, 95% CI 0.51–0.97). Risk-adjusted comparison of revascularization strategies for diabetics with 2-vessel CAD suggested no significant benefit of CABG relative to PCI (HR 0.92, 95% CI 0.58–1.46).
Conclusion: This registry-based observational study suggests a survival benefit of CABG relative to PCI in diabetic patients with ACS and 3-vessel CAD. However, in diabetic patients with ACS and 2-vessel CAD, CABG and PCI resulted in comparable 5-year survival.