Revascularization outcomes in diabetic patients presenting with acute coronary syndrome with non-ST elevation

Area of Science:

• Cardiology
• Interventional Cardiology
• Diabetology

Background:

• Diabetic patients with acute coronary syndromes (ACS) like NSTEMI or UA require careful consideration for revascularization strategies.
• Real-world data comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in this high-risk population is crucial.
• Understanding long-term outcomes is essential for optimizing treatment guidelines for diabetic ACS patients.

Purpose of the Study:

• To compare the long-term outcomes of diabetic patients hospitalized with NSTEMI or UA who underwent either CABG or PCI.
• To identify predictors for choosing CABG over PCI in diabetic patients with NSTEMI/UA.
• To evaluate the real-world effectiveness of CABG versus PCI in this specific patient cohort.

Main Methods:

• Retrospective analysis of 1987 diabetic patients hospitalized for NSTEMI or UA between 2000-2016.
• Patients underwent either PCI (83%) or CABG (17%).
• Propensity score-matched analysis (200 pairs) compared all-cause mortality between PCI and CABG groups.

Main Results:

• Independent predictors for CABG included 3-vessel disease, absence of on-site cardiac surgery, no prior PCI, and no prior MI.
• No significant difference in mortality at 2 years between PCI and CABG groups (log-rank p=0.996).
• After 2 years, CABG showed a significant survival benefit (HR 1.53, p=0.021), confirmed by propensity score matching (log-rank p=0.031).

Conclusions:

• In real-world practice, CABG is associated with better long-term outcomes for diabetic patients with NSTEMI/UA compared to PCI.
• The findings suggest a potential long-term advantage of surgical revascularization in this population.
• Prospective randomized trials are recommended to establish definitive evidence for future clinical guidelines.