Abstract 16707: Improved Long-term Survival for Diabetic Patients With Surgical vs. Interventional Revascularization in a Contemporary Community-Based Registry
Background: Diabetes is increasing at an alarming rate, affecting nearly 8% of the population. Previous studies have demonstrated a potential benefit for surgical over interventional revascularization in diabetics. However, randomized clinical trials comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) many not accurately reflect current clinical practice. We therefore undertook a prospective registry of coronary revascularization (CR) in diabetic patients with CABG, on- and off-pump, and PCI with bare-metal and drug-eluting stents to determine long-term clinical outcomes.
Methods and Results: All patients undergoing isolated CR in 8 community hospitals were enrolled. Follow-up was obtained after 5-8 yrs; all mortalities were checked against the Social Security Death Index. ST-elevation myocardial infarction and salvage patients were excluded. Of the 3,156 patients in the registry, there were 1082 diabetics: 334 CABG and 748 PCI. Cox regression revealed that survival was improved in the CABG vs. PCI group with an hazard ratio (HR)=0.74 (95% Confidence intervals (CI): 0.56, 0.99; p=0.040), while event free survival similarly favored CABG with an HR=0.75 (CI 0.58, 0.97; p=0.029). Due to the differences in baseline characteristics between the two groups, propensity score matching was used to achieve clinically comparable groups of 237 patients each. In matched patient groups mortality was more common in the PCI group with an Odds Ratio (OR) of 0.69 (CI 0.50, 0.97; p=0.031). Similarly, occurrence of any MACE (mortality, non-fatal MI or revascularization) was more frequent in the PCI group with an OR of 0.57 (CI 0.38, 0.83, p=0.004). Kaplan-Meier event-free survival of matched groups was significantly improved in the CABG vs. PCI group (p=0.047).
Conclusions: In the current era of on- and off-pump CABG surgery and BMS and DES, this registry which records all nonSTEMI patients undergoing coronary revascularization, diabetic patients benefit from improved long-term survival and reduced MACE with CABG vs. PCI. These findings corroborate recent evidence from prospective randomized trials and validate their broad applicability to diabetics with extensive coronary artery disease in need of CR.
- © 2013 by American Heart Association, Inc.