Abstract 20356: Comparison of CABG versus PCI Outcomes in Diabetic, Mutivessel Coronary Artery Disease Patients With and Without Acute Coronary Syndromes
Purpose: The FREEDOM trial demonstrated that coronary artery bypass grafting (CABG) results in better survival free of death, myocardial infarction (MI) or stroke than percutaneous intervention with drug eluting stents (PCI) in patients with diabetes (DM) and multivessel coronary disease (mCAD). We examined whether this was the case for subgroups presenting with and without an acute coronary syndromes (ACS). In some series, patients with non-ST elevation MI (NSTEMI) ACS at the time of CABG experienced excess cardiovascular events when compare to PCI.
Methods: Kaplan-Meier estimates used to compare post-CABG and post-PCI survivals. Comparisons were adjusted for baseline imbalances between ACS and non-ACS cohorts using Cox proportional-hazards regression.
Results: When compared to non-ACS, ACS subjects were more likely to have a history of prior MI and be current smokers and had worse long-term survival (HR=1.26, p=0.04). CABG was superior to PCI (Fig 1, Table1) for both groups (with and without adjusting for baseline imbalances).
Kaplan: Meier Estimates of Primary Composite† Outcome at 30 days and 5 Years after Randomization presented by baseline ACS status
Conclusions: For patients presenting with DM, and mCAD, CABG improves survival free of death, MI, or stroke compared to PCI whether or not the patients present with an ACS.
Author Disclosures: M.E. Farkouh: None. M. Domanski: None. V. Fuster: None.
- © 2014 by American Heart Association, Inc.