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Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Diabetes and
Derrick Y Tam1, Christoffer Dharma2, Rodolfo Rocha3
1Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Insights
For patients with diabetes and multivessel coronary artery disease, coronary artery bypass grafting (CABG) shows better long-term survival and fewer major cardiovascular events than percutaneous coronary intervention (PCI). CABG is linked to improved outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Limited real-world data exists comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for diabetic patients with multivessel coronary artery disease (CAD).
- This study addresses the need for comparative evidence on the long-term effectiveness of PCI versus CABG in this specific patient population.
Purpose of the Study:
- To compare the early and long-term clinical outcomes of PCI and CABG in patients with diabetes and multivessel CAD.
- To evaluate differences in all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCEs) between the two treatment strategies.
Main Methods:
- A population-based cohort study using linked clinical and administrative databases in Ontario, Canada (2008-2017).
- Included patients with diabetes and 2- or 3-vessel CAD treated with PCI or isolated CABG.
- A 1:1 propensity score matching was used to balance baseline characteristics, followed by survival analysis using Cox proportional hazards models.
Main Results:
- After propensity score matching (4,301 pairs), there was no significant difference in early mortality between PCI and CABG groups.
- Long-term follow-up (median 5.5 years) revealed significantly higher all-cause mortality (HR: 1.39) and MACCEs (HR: 1.99) in the PCI group compared to the CABG group.
- These findings were consistent across various baseline covariates.
Conclusions:
- Coronary artery bypass grafting (CABG) is associated with improved long-term mortality and reduced rates of major adverse cardiovascular and cerebrovascular events (MACCEs) compared to percutaneous coronary intervention (PCI).
- CABG may be the preferred revascularization strategy for diabetic patients with multivessel coronary artery disease, based on these real-world observational data.
Background:
There remains a paucity of real-world observational evidence comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with diabetes and multivessel coronary artery disease (CAD).
Objectives:
This study compared early and long-term outcomes of PCI versus CABG in patients with diabetes.
Methods:
Clinical and administrative databases in Ontario, Canada were linked to obtain records of all patients with diabetes with angiographic evidence of 2- or 3-vessel CAD who were treated with either PCI or isolated CABG from 2008 to 2017. A 1:1 propensity score match was performed to account for baseline differences. All-cause mortality and the composite of myocardial infarction, repeat revascularization, stroke, or death (termed major cardiovascular and cerebrovascular events [MACCEs]) were compared between the matched groups using a stratified log-rank test and Cox proportional hazards model.
Results:
A total of 4,519 and 9,716 patients underwent PCI and CABG, respectively. Before matching, patients who underwent CABG were significantly younger (age 65.7 years vs. 68.3 years), were more likely to be men (78% vs. 73%) and had more severe CAD. Propensity score matching based on 23 baseline covariates yielded 4,301 well-balanced pairs. There was no difference in early mortality between PCI and CABG (2.4% vs. 2.3%; p = 0.721) after matching. The median and maximum follow-ups were 5.5 and 11.5 years, respectively. All-cause mortality (hazard ratio [HR]: 1.39; 95% CI: 1.28 to 1.51) and overall MACCEs (HR: 1.99; 95% CI: 1.86 to 2.12) were significantly higher with PCI compared with CABG.
Conclusions:
In patients with multivessel CAD and diabetes, CABG was associated with improved long-term mortality and freedom from MACCEs compared with PCI.
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