Abstract 15085: Long-Term Outcomes of Patients With Coronary Artery Disease and Type 2 Diabetes Mellitus With Chronic Kidney Disease Undergoing Surgery, Angioplasty, or Medical Treatment
Background: Diabetes (DM) is related to worse prognosis in coronary artery disease (CAD) patients. There is an additional risk when chronic kidney disease (CKD) is present. Few data are available comparing therapies for CAD in patients with DM and CKD. Objective: To compare different therapies for CAD among diabetic patients stratified by renal function.
Methods: This is a prospective, registry-based study that enrolled patients at Heart Institute (InCor), University of São Paulo. Enrollment period started in 2003 up to 2010. Type 2 DM patients with multivessel CAD and normal ventricular function were allocated to therapies: surgery (CABG), angioplasty with bare-metal stents (BMS), drug-eluting stents (DES), or medical therapy (MT). Data were analyzed applying 3 strata according estimated glomerular filtration rate: 1) normal (> 90mL/min), 2) mild CKD (60-89mL/min), and 3) moderate CKD (30-59mL/min). Endpoints were overall mortality, acute myocardial infarction (AMI) and need for new revascularization.
Results: Patients (N=469) were followed for a mean time of 5.04 years. Among stratum 1 (N=174), 72 underwent CABG, 31 DES, 50 MT and 21 BMS; stratum 2 (N=212), 83 underwent CABG, 35 DES, 70 MT and 24 BMS; stratum 3 (N=83), 28 underwent CABG, 18 DES, 27 MT and 10 BMS. Baseline profile was similar among groups, except for a higher percentage of 3-vessel disease in CABG group. In stratum 1 there were no differences regarding overall mortality and AMI. Survival free of new revascularization rates for CABG, DES, MT and BMS were 97.2%, 90.3%, 80% and 71.4% (P=0.009). For stratum 2 there were no differences regarding endpoints considered. For patients in stratum 3, survival rates for CABG, DES, MT and BMS were 92.9%, 88.9%, 88.9%, and 100% respectively (P=0.019 for CABG versus DES). Survival free of AMI rates were 96.4 in CABG, 77.8% in DES; 96.3% in MT, and 100% in BMS group (P=0.036). Survival free of new procedures rates were 100% for CABG, 77.8% for DES, 88.9% for MT, and 100% for BMS (P=0.012 for CABG versus DES).
Conclusion: In patients with CAD and DM it was observed superiority of CABG over DES in relation to new revascularization rates in normal renal function stratum. Besides, among moderate CKD patients, there were higher rates of death, AMI, and new procedures in DES group.
- © 2013 by American Heart Association, Inc.