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Everolimus-Eluting Stents or Bypass Surgery for Multivessel Disease in Diabetics: The BEST Extended Follow-Up Study

Hoyun Kim1, Do-Yoon Kang1, Jung-Min Ahn1

  • 1Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

JACC. Cardiovascular Interventions
|October 11, 2023
PubMed

Insights

For patients with multivessel coronary artery disease, coronary artery bypass grafting (CABG) shows better outcomes than percutaneous coronary intervention (PCI) in diabetics. Mortality rates were similar between CABG and PCI regardless of diabetes status.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diabetes Mellitus Research

Background:

  • Diabetes mellitus is linked to more complex coronary artery disease.
  • Coronary artery bypass grafting (CABG) is often preferred over percutaneous coronary intervention (PCI) for diabetics with multivessel coronary artery disease (MVD).

Purpose of the Study:

  • To evaluate the prognostic impact of revascularization strategies (PCI vs. CABG) based on diabetes status.
  • To analyze outcomes from the BEST trial, comparing PCI with everolimus-eluting stents to CABG in MVD patients.

Main Methods:

  • 880 patients with MVD were randomized to PCI or CABG.
  • Patients were stratified into diabetic (n=363) and nondiabetic (n=517) groups.
  • The primary endpoint was a composite of death, myocardial infarction, or target vessel revascularization over an 11.8-year median follow-up.

Main Results:

  • Diabetic patients had a significantly higher primary endpoint rate with PCI versus CABG (43% vs. 32%).
  • No significant difference in the primary endpoint was observed between PCI and CABG in nondiabetic patients (29% vs. 29%).
  • Repeat revascularization rates were higher with PCI compared to CABG, irrespective of diabetes status.

Conclusions:

  • CABG demonstrated superior clinical outcomes compared to PCI in diabetic patients with MVD.
  • Mortality rates were comparable between PCI and CABG across both diabetic and nondiabetic groups during extended follow-up.
Abstract

Keywords:
bypass surgerycoronary interventiondiabetesmultivessel diseasestent(s)

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