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Ten-year all-cause death after percutaneous or surgical revascularization in diabetic patients with complex coronary
Rutao Wang1,2,3, Patrick W Serruys2,4, Chao Gao1,2,3
1Department of Cardiology, Xijing Hospital, Changle West Road 127, Xi'an 710032, China.
Insights
Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) showed similar 10-year survival rates for patients with three-vessel disease. However, CABG may offer a survival benefit for insulin-treated diabetic patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diabetology
Background:
- Coronary artery disease (CAD) management involves revascularization strategies like CABG and PCI.
- Diabetes mellitus is a significant comorbidity impacting cardiovascular outcomes.
- Long-term comparative data on revascularization strategies in diabetic patients with complex CAD are crucial.
Purpose of the Study:
- To compare 10-year all-cause mortality rates after CABG versus PCI in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD).
- To analyze these outcomes based on the presence and treatment of diabetes.
Main Methods:
- Analysis of 1800 patients from the SYNTAX trial randomized to PCI or CABG.
- Evaluation of 10-year survival data stratified by diabetic status.
- Examination of outcomes in insulin-treated diabetic patients.
Main Results:
- No significant difference in 10-year all-cause death between PCI and CABG overall (absolute difference 1.9% in diabetics).
- Numerically higher mortality with PCI versus CABG at 5 years in diabetics (19.6% vs. 13.3%).
- Numerically higher mortality with PCI versus CABG at 10 years in insulin-treated diabetics (47.9% vs. 39.6%).
Conclusions:
- Revascularization strategy (PCI vs. CABG) had similar 10-year all-cause mortality regardless of diabetes status.
- CABG may offer a survival advantage in insulin-treated diabetic patients.
- Further trials are needed to investigate long-term outcomes in diabetic patients undergoing PCI versus CABG.
Aims:
The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes.
Methods And Results:
The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: -7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: -6.5%, 22.5%, P = 0.227).
Conclusions:
The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials.
Trial Registration:
SYNTAX: ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.
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