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Drug-eluting stents compared with bilateral internal thoracic artery grafts for diabetic patients
Yaron Moshkovitz1, Rephael Mohr, Benjamin Medalion
1Assuta Medical Center, Tel Aviv, Israel.
Insights
Diabetic patients with multivessel coronary artery disease had better long-term survival and fewer adverse events with bilateral internal thoracic artery (BITA) grafting compared to drug-eluting stents (DES) percutaneous coronary intervention (PCI). This study highlights BITA grafting as a superior revascularization strategy for this high-risk population.
Area of Science:
- Cardiology
- Vascular Surgery
- Diabetic Complications
Background:
- Diabetic patients with multivessel coronary artery disease face higher risks after coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI).
- Previous studies showed no survival differences between CABG and PCI in this population.
- This study specifically compares drug-eluting stents (DES) with bilateral internal thoracic artery (BITA) grafting in diabetic patients with multivessel coronary artery disease.
Purpose of the Study:
- To compare the long-term outcomes of BITA grafting versus DES PCI in diabetic patients with multivessel coronary artery disease.
- To determine if one revascularization strategy offers superior survival and reduced adverse cardiovascular events.
Main Methods:
- Retrospective evaluation of diabetic patients undergoing left-sided arterial revascularization with BITA grafting (2002-2006).
- Comparison of outcomes with diabetic patients undergoing PCI with DES (Cypher).
- Utilized Cox proportional hazards model with propensity score adjustment to identify predictors of outcome events.
Main Results:
- The BITA group (226 patients) showed significantly better 5-year reintervention-free survival (86% vs. 65%) and major adverse cardiovascular events-free survival (81% vs. 54%) compared to the DES group (271 patients).
- PCI with DES was associated with decreased adjusted survival (HR 3.01) and increased risk of target vessel reinterventions (HR 7.00).
- Increased number of DES-treated vessels correlated with a higher adjusted risk of major adverse cardiovascular events.
Conclusions:
- This study provides the first evidence of significantly better long-term adjusted survival and outcomes for diabetic patients undergoing CABG with BITA grafting compared to PCI with DES.
- BITA grafting represents a superior revascularization strategy for diabetic patients with multivessel coronary artery disease.
- Further research may explore the mechanisms behind these outcome differences.
Background:
Diabetic patients with multivessel coronary artery disease who undergo coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI) are at greater risk of late morbidity and mortality than nondiabetic patients. We questioned earlier comparisons of these two approaches that showed no differences in survival rates. This study compares drug-eluting stents (DES) and bilateral internal thoracic artery (BITA) grafting in diabetic patients with multivessel coronary artery disease.
Methods:
All diabetic patients who underwent left-sided arterial revascularization with BITA grafting between January 2002 and May 2006 were evaluated. Their outcomes were compared with those of diabetic patients who underwent PCI with DES (Cypher). The Cox proportional hazards model defined predictors of outcome events after forcing propensity score with patients' characteristics into the model.
Results:
The outcomes of 226 BITA patients were compared with those of 271 DES patients (mean follow-up 62 months). The 5-year reintervention-free survival (Kaplan-Meier 86% versus 65%, log rank p = 0.000) and major adverse cardiovascular events-free survival (81% versus 54%, p = 0.001) were significantly better in the BITA group. Assignment to the PCI group was associated with decreased adjusted survival (hazard ratio 3.01, 95% confidence interval: 1.59 to 5.73, p = 0.000) and increased risk of target vessel reinterventions (hazard ratio 7.00, 95% confidence interval: 3.1 to 15.70). The adjusted risk of major adverse cardiovascular events increased with the number of DES-treated vessels.
Conclusions:
This is the first demonstration of significantly better long-term adjusted survival and outcomes of diabetic patients who underwent CABG with BITA grafting compared with diabetic patients who underwent PCI with DES.