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Causes of Death After Coronary Revascularization in Patients With Diabetes
Lucas C Godoy1, Valentin Fuster2, Louai Razzouk3
1Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Instituto do Coração (InCor), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
Insights
In patients with diabetes and multivessel coronary artery disease, percutaneous coronary intervention (PCI) increases long-term ischemia-related mortality, particularly sudden cardiac death, compared to coronary artery bypass grafting (CABG). Further research should focus on reducing myocardial infarction post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary artery disease (CAD) has shown higher long-term cardiovascular mortality than coronary artery bypass grafting (CABG).
- Specific causes of death following PCI versus CABG in this high-risk population remain incompletely understood.
Purpose of the Study:
- To investigate and compare the causes of long-term mortality in diabetic patients with multivessel CAD undergoing either PCI or CABG for revascularization.
Main Methods:
- Analysis of centrally adjudicated causes of death from 1900 participants in the FREEDOM trial.
- Utilized cause-specific hazard ratios (csHRs) to compare mortality rates between PCI and CABG groups.
Main Results:
- Sudden cardiac death (SCD) was the leading cause of cardiovascular mortality (40%), followed by myocardial infarction (MI) (16%).
- PCI was associated with significantly increased rates of SCD (csHR, 2.04) and the composite of SCD and MI (csHR, 2.10) compared to CABG.
- PCI showed a nonsignificant trend towards higher overall cardiovascular mortality (csHR, 1.35) versus CABG.
Conclusions:
- Sudden cardiac death is the primary cause of long-term mortality in diabetic patients with multivessel CAD after revascularization.
- PCI is linked to elevated long-term ischemia-related mortality, including SCD, when compared to CABG.
- Future strategies should emphasize refining PCI techniques and secondary prevention to mitigate post-procedural myocardial infarction risk.
Background:
In patients with diabetes and multivessel coronary artery disease, percutaneous coronary intervention (PCI) has been associated with higher long-term cardiovascular mortality compared with coronary artery bypass grafting (CABG), but the specific causes of death are not well known. We aimed to determine the causes of death of patients with diabetes and multivessel disease undergoing coronary revascularization with PCI vs CABG.
Methods:
We analyzed the centrally adjudicated causes of death of 1900 participants in the FREEDOM trial. Cause-specific hazard ratios (csHRs) were used to compare mortality rates.
Results:
There were 197 deaths during the 5 years of follow-up; 63.5% were classified as cardiovascular deaths and the remaining (36.5%), noncardiovascular deaths. Sudden cardiac death was the most common cause of cardiovascular mortality (40% of all cardiovascular deaths), followed by myocardial infarction deaths (16% of all cardiovascular deaths). Compared with CABG, PCI was associated with increased ischemia-related mortality, namely, sudden cardiac death (csHR, 2.04; 95% CI, 1.13-3.70; P = .02) and the composite of sudden cardiac death and myocardial infarction death (csHR, 2.10; 95% CI, 1.27-3.48, P = .004). PCI was associated with a nonsignificant increase in overall cardiovascular mortality compared with CABG (csHR, 1.35; 95% CI, 0.95-1.93; P = .09).
Conclusions:
Sudden cardiac death was the most common cause of long-term mortality of patients with diabetes and multivessel coronary artery disease undergoing a revascularization procedure. Compared with CABG, PCI was associated with increased long-term rates of ischemia-related mortality. Operative techniques and secondary prevention should target reducing post-revascularization spontaneous myocardial infarction in patients treated with PCI.
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