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Comparison of bilateral thoracic artery grafting with percutaneous coronary interventions in diabetic patients
Chaim Locker1, Rephael Mohr, Oren Lev-Ran
1Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6Tel Aviv 64239, Israel.
Insights
Bilateral internal thoracic artery grafting (BITA) offers superior long-term outcomes for diabetic patients with complex coronary artery disease compared to percutaneous coronary intervention (PCI). BITA is recommended for left main or three-vessel disease, while PCI suits simpler cases.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Diabetic patients present unique challenges for myocardial revascularization.
- Comparing percutaneous coronary intervention (PCI) with bilateral internal thoracic artery grafting (BITA) is crucial for optimizing treatment strategies in this population.
Purpose of the Study:
- To compare the long-term outcomes of PCI versus BITA in diabetic patients undergoing myocardial revascularization.
- To identify patient subgroups that benefit most from each revascularization strategy.
Main Methods:
- A retrospective analysis of 802 diabetic patients who underwent myocardial revascularization between May 1996 and December 1999.
- 363 patients received PCI, and 439 received BITA, with baseline characteristics and procedural details recorded.
- Follow-up data on angina recurrence, reintervention rates, cardiovascular events, and survival were collected.
Main Results:
- BITA group had more vessels treated (3.4 vs. 1.2). Thirty-day mortality was similar (3.4% BITA vs. 2.8% PCI).
- Late follow-up (3-6.5 years) showed significantly better outcomes for BITA: less angina (11% vs. 64%), fewer reinterventions (2.7% vs. 55%), and improved event-free survival (80% vs. 30%).
- Six-year survival was comparable (85.5% BITA vs. 81.2% PCI), but BITA significantly improved survival in patients with left main or three-vessel disease (86% vs. 76%).
Conclusions:
- Despite a higher surgical risk profile, BITA demonstrates superior late-term outcomes in diabetic patients compared to PCI.
- Diabetic patients with single or double-vessel disease may be suitable for PCI.
- Diabetic patients with three-vessel or left main coronary artery disease are better served by surgical revascularization with BITA.
Background:
This study compares the outcome of percutaneous coronary interventions (PCI) with bilateral internal thoracic grafting (BITA) in diabetic patients.
Methods:
From May 1996 to December 1999, 802 consecutive diabetic patients underwent myocardial revascularization: 363 by PCI and 439 by BITA. The two groups were similar; however, left main disease (28% versus 3.3%), ejection fraction less than 0.35 (14.5% versus 5.5%), and chronic obstructive lung disease (8.4% versus 3%) were more prevalent in the BITA group, and prior percutaneous transluminal coronary angioplasty, in the PCI group (16.8% versus 10.5%).
Results:
The number of coronary vessels treated per patient was higher in the BITA group (3.4 versus 1.2; p < 0.001). Thirty-day mortality was similar: 3.4% in the BITA group and 2.8% in the PCI group. Late follow-up (3 to 6.5 years) showed decreased return of angina (11% versus 64%; p < 0.001), fewer reinterventions (2.7% versus 55%; p < 0.001), and increased cardiovascular event-free survival (80% versus 30%; p < 0.001) in the BITA group. Six-year survival of BITA and PCI patients was 85.5% and 81.2%, respectively (not significant). However, survival of the subgroups of patients with left main or three-vessel coronary artery disease was significantly better with BITA (86% versus 76%; p = 0.003).
Conclusions:
Despite higher risk profile of diabetic patients treated surgically by BITA, their late outcome is better than that of patients treated by PCI. The results of this study support referring diabetics with single-vessel or double-vessel disease to PCI and those with three-vessel and left main coronary artery disease to surgery.
