Coronary Artery Bypass Surgery Improves Outcomes in Patients With Diabetes and Left Ventricular Dysfunction
Jeevan Nagendran1, Sabin J Bozso2, Colleen M Norris1
1Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
Insights
For patients with diabetes mellitus and coronary artery disease with left ventricular dysfunction, coronary artery bypass grafting offers better long-term survival than percutaneous coronary intervention without increasing stroke risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Large trials established percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) roles in diabetes mellitus (DM) and multivessel coronary artery disease (CAD).
- These trials often excluded patients with left ventricular dysfunction (LVD).
Purpose of the Study:
- To compare outcomes of PCI versus CABG in patients with DM, CAD, and LVD.
- To determine if PCI or CABG improves outcomes in this specific patient population.
Main Methods:
- A propensity-matched study compared outcomes for patients with CAD, DM, and LVD treated with PCI or CABG (2004-2016).
- Primary outcome: major adverse cardiac and cerebrovascular events (MACCE) including death, stroke, myocardial infarction (MI), and repeat revascularization.
- Secondary outcomes: individual components of MACCE.
Main Results:
- PCI was linked to higher MACCE risk in patients with ejection fraction (EF) 35%-49% and <35%.
- PCI increased mortality risk in both EF groups and MI risk in the EF <35% group.
- Repeat revascularization was more frequent after PCI in both EF groups; stroke rates were similar.
Conclusions:
- Coronary artery bypass grafting (CABG) demonstrated significantly lower MACCE incidence and better long-term survival compared to percutaneous coronary intervention (PCI).
- CABG did not increase stroke risk relative to PCI in patients with CAD, DM, and LVD.
Background:
The role of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) has been established by large trials; however, these trials largely excluded patients with left ventricular dysfunction (LVD).
Objectives:
The aim of this study was to determine whether treatment with PCI or CABG leads to improved outcomes in patients with DM, CAD, and LVD.
Methods:
In this propensity-matched study, outcomes were compared for patients with CAD, DM, and LVD treated with PCI or CABG between 2004 and 2016. The primary outcome was major adverse cardiac and cerebrovascular events, defined as the composite of death, stroke, myocardial infarction, and repeat revascularization. Secondary outcomes were the individual components of the primary outcome.
Results:
PCI compared with CABG was associated with a higher risk for major adverse cardiac and cerebrovascular events in cohorts with ejection fraction (EF) 35% to 49% (p < 0.001) and <35% (p < 0.001). Treatment with PCI was associated with an increased risk for death in both the EF 35% to 49% and the EF <35% cohorts. Stroke rate did not differ between PCI and CABG in either EF cohort. PCI was associated with an increased rate of MI in the EF <35% cohort, and repeat revascularization occurred more frequently in patients treated with PCI in both the EF 35% to 49% cohort and the EF <35% cohort.
Conclusions:
At long-term follow-up, patients with CAD, DM, and LVD treated with CABG exhibited a significantly lower incidence of major adverse cardiac and cerebrovascular events and better long-term survival over PCI, without a higher risk for stroke.
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