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Outcomes of repeat revascularization in diabetic patients with prior coronary surgery
Jason H Cole1, Ellis L Jones, Joseph M Craver
1Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
For diabetic patients needing repeat revascularization after coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI) offers comparable long-term survival to repeat CABG, with lower initial risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetic Cardiovascular Health
Background:
- Diabetic patients with multivessel coronary disease often benefit from initial coronary artery bypass graft surgery (CABG).
- Revascularization choices for diabetic patients with prior CABG are less certain.
- This study addresses outcomes for diabetic patients undergoing repeat revascularization.
Purpose of the Study:
- To evaluate short- and long-term outcomes of diabetic patients.
- To compare repeat coronary artery bypass graft surgery (CABG) versus percutaneous coronary intervention (PCI) after initial CABG.
- To identify predictors of mortality in this patient population.
Main Methods:
- Retrospective analysis of 15 years of data for diabetic patients undergoing repeat CABG or PCI post-CABG.
- Comparison of baseline characteristics between PCI and repeat CABG groups.
- Calculation of in-hospital, 5-year, and 10-year mortality rates; multivariate analysis for mortality predictors.
Main Results:
- In-hospital mortality was higher for repeat CABG compared to PCI.
- No significant difference in 10-year mortality between PCI (68%) and repeat CABG (74%) groups (p=0.14).
- Older age, hypertension, low ejection fraction, and heart failure-PCI interaction predicted long-term mortality; PCI itself did not.
Conclusions:
- Repeat CABG in diabetic patients carries a higher initial risk.
- Long-term mortality is comparable between PCI and repeat CABG for diabetic patients.
- Percutaneous coronary intervention (PCI) should be strongly considered for diabetic patients with prior CABG, except those with severe heart failure.
Objectives:
This study evaluated both short- and long-term outcomes of diabetic patients who underwent repeat coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) after initial CABG.
Background:
Although diabetic patients who have multivessel coronary disease and require initial revascularization may benefit from CABG as compared with PCI, the uncertainty concerning the choice of revascularization may be greater for diabetic patients who have had previous CABG.
Methods:
Data were obtained over 15 years for diabetic patients undergoing PCI procedures or repeat CABG after previous coronary surgery. Baseline characteristics were compared between groups, and in-hospital, 5-year, and 10-year mortality rates were calculated. Multivariate correlates of in-hospital and long-term mortality were determined.
Results:
Both PCI (n = 1,123) and CABG (n = 598) patients were similar in age, gender, years of diabetes, and insulin dependence, but they varied in presence of hypertension, prior myocardial infarction, angina severity, heart failure, ejection fraction, and left main disease. In-hospital mortality was greater for CABG, but differences in long-term mortality were not significant (10 year mortality, 68% PCI vs. 74% CABG, p = 0.14). Multivariate correlates of long-term mortality were older age, hypertension, low ejection fraction, and an interaction between heart failure and choice of PCI. The PCI itself did not correlate with mortality.
Conclusions:
The increased initial risk of redo CABG in diabetic patients and the comparable high long-term mortality regardless of type of intervention suggest that, except for patients with severe heart failure, PCI be strongly considered in all patients for whom there is a percutaneous alternative.