Abstract 4677: Drug-Eluting Stents versus Coronary-Artery Bypass Grafting for Multivessel Coronary Artery Disease in Patients With Diabetes
BACKGROUND Patients with diabetes have an increased incidence and severity of coronary artery disease. Several studies have compared the treatment effects of coronary stenting with drug-eluting stents and coronary-artery bypass grafting (CABG). However, there are limited data regarding the long-term safety and efficacy of these two interventions for patients with diabetes.
METHODS We evaluated 1537 multivessel coronary artery disease patients with diabetes who underwent drug-eluting stent implantation or CABG in our institution between April 2004 and December 2006. We compared safety (death; a composite of death or myocardial infarction; and non-fatal stroke); and efficacy (target-vessel revascularization) with the use of adjustment for differences in baseline risk factors and propensity-score analysis.
RESULTS Patients who underwent CABG (n=829) were older and had more comorbidities than patients who received drug-eluting stents (n=708). Patients receiving drug-eluting stents had considerably higher 3-year rates of death (adjusted hazard ratio [HR] for the drug-eluting stents, 1.50; 95% confidence interval [CI], 1.04 to 2.89), the composite outcome of death or myocardial infarction (adjusted HR, 1.32; 95% confidence interval [CI], 1.05 to 2.72) and target-vessel revascularization (adjusted HR, 5.26; 95% confidence interval [CI], 2.30 to 12.46). However, CABG stents were associated with higher rates of non-fatal stroke (adjusted HR for the drug-eluting stents, 0.71, 95%CI 0.44 to 0.97).
CONCLUSIONS In a cohort of multivessel coronary artery disease patients with diabetes, we found that stenting with drug-eluting stents was associated with higher rates of death, the composite outcome of death or MI, and target-vessel revascularization than was CABG. However, CABG was associated with higher rates of non-fatal stroke than was stenting of drug-eluting stents.