Comparative efficacy of coronary artery bypass surgery vs. percutaneous coronary intervention in patients with...

Area of Science:

• Cardiology
• Nephrology
• Vascular Surgery

Background:

• Optimal coronary revascularization strategy for patients with diabetes mellitus (DM), multivessel coronary artery disease (CAD), and chronic kidney disease (CKD) is unclear.
• This study addresses the unknown optimal treatment in this complex patient population.

Purpose of the Study:

• To compare the cardiovascular outcomes of coronary artery bypass surgery (CABG) versus percutaneous coronary intervention (PCI) in patients with DM.
• To specifically evaluate these outcomes in patients with and without CKD.

Main Methods:

• Subgroup analysis of the FREEDOM trial ('as-treated' approach) involving patients with DM stratified by CKD status (eGFR < 60 mL/min/1.73m²).
• Comparison of baseline characteristics and clinical outcomes between CABG and PCI groups within CKD strata.
• Primary endpoint: composite of all-cause death, stroke, or myocardial infarction (MACCE) at 5 years, analyzed using Kaplan-Meier and Cox regression.

Main Results:

• Patients with CKD were older and more frequently female. CABG demonstrated consistent efficacy compared to PCI for MACCE in both CKD (26.0% vs. 35.6%) and non-CKD (16.2% vs. 23.6%) groups, with no significant interaction (p=0.83).
• While stroke rates were non-significantly higher with CABG, rates of myocardial infarction and repeat revascularization were significantly reduced in both groups.

Conclusions:

• Coronary artery bypass grafting (CABG) demonstrates preserved long-term efficacy for major adverse cardiovascular and cerebrovascular events (MACCE) compared to percutaneous coronary intervention (PCI) in patients with mild to moderate chronic kidney disease (CKD).
• These findings support CABG as a viable revascularization option for diabetic patients with multivessel CAD and CKD.