Abstract 13210: Real-world Comparing Outcomes of Revascularization Strategies for Multivessel Disease in Patients with Diabetes
Introduction: Randomized trials comparing revascularization strategies for patients with diabetes report that coronary-artery bypass grafting (CABG) has a better outcome than percutaneous coronary intervention (PCI).
Hypothesis: Evidence from a more generalizable population of patients is still lacking. This study investigated clinical outcomes in a large cohort of patients with DM and multivessel coronary artery disease (CAD) after CABG or PCI in contemporary practice.
Methods: All 4,148 consecutive patients who underwent isolated CABG (n = 1,853) or PCI (n = 2,295) at our institution for the years 2004 through 2008 were included. Both in-hospital and 4-year major adverse cardiac cerebrovascular events (MACCE) including death, myocardial infarction (MI), stroke, and repeat revascularization were compared with the use of the inverse probability weighted method.
Results: After adjustment for differences in baseline risk factors, the 4-year risk of all-cause death (hazard ratio [HR] 2.19, p=0.015), MI (HR 2.79, p=0.022), repeat revascularization (HR 4.85, p<0.001) and MACCE (HR 1.78, P<0.001) was higher for patients undergoing PCI versus CABG. While stroke was less frequent in patients treated with PCI (HR 0.52, p=0.024). A statistically significant interaction between revascularization strategy and insulin treatment was present with respect to repeat revascularization (P<0.001) and MACCE (P=0.011). Revascularization with PCI resulted in higher MACCE for both patients with three-vessel disease (HR: 1.70; 95% CI: 1.19-2.42) and patients with left main disease (HR: 3.64; 95% CI: 1.82-7.29).
Conclusions: In contemporary practice, for patients with diabetes and two or more diseased coronary arteries, there is a significant advantage of CABG over PCI in overall survival, and reduction of myocardial infarction and repeat revascularization, with a higher risk of stroke.
- Ischemic heart disease
- Diabetes mellitus
- Coronary artery bypass grafting (CABG)
- Percutaneous coronary intervention (PCI)
Author Disclosures: Z. Zheng: None. H. Zhang: None. X. Yuan: None. B. Xu: None. C. Rao: None. W. Wang: None. S. Hu: None.
- © 2014 by American Heart Association, Inc.