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Revascularization in Diabetic Patients With Non-ST-Elevation Acute Myocardial Infarction
Thiago L Scudeler1,2, Leandro M Alves da Costa1, José Roberto de Oliveira Silva Filho2
1Department of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Insights
Coronary artery bypass graft (CABG) showed lower 5-year mortality for diabetic patients with non-ST-elevation myocardial infarction (NSTEMI) compared to percutaneous coronary intervention (PCI). CABG is linked to better survival outcomes in this high-risk population.
Area of Science:
- Cardiology
- Diabetology
- Health Services Research
Background:
- Diabetic patients with non-ST-elevation myocardial infarction (NSTEMI) face complex treatment decisions regarding myocardial revascularization.
- Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are primary revascularization strategies, each with distinct risk-benefit profiles in this population.
Purpose of the Study:
- To compare the 5-year all-cause mortality and major adverse cardiovascular events in diabetic patients hospitalized with NSTEMI who underwent either CABG or PCI.
- To evaluate the real-world effectiveness of CABG versus PCI in a large cohort of diabetic patients with NSTEMI.
Main Methods:
- A real-world evidence study utilizing the TriNetX global health research network, including 18,115 diabetic patients with NSTEMI.
- Propensity score matching was employed to create comparable groups for CABG and PCI, followed by a 5-year all-cause mortality analysis.
- Hazard ratios and confidence intervals were calculated to assess the comparative effectiveness of the two revascularization strategies.
Main Results:
- Coronary artery bypass graft (CABG) was associated with significantly lower 5-year all-cause mortality (10.6%) compared to percutaneous coronary intervention (PCI) (17.9%) in diabetic patients with NSTEMI.
- The PCI group experienced higher rates of subsequent myocardial infarction and additional coronary revascularization procedures within 5 years.
- Propensity score matching confirmed CABG's survival benefit (HR, 0.685; 95% CI, 0.618-0.759; P<.0001).
Conclusions:
- In this real-world cohort, CABG demonstrated a superior survival benefit over PCI for diabetic patients experiencing non-ST-elevation myocardial infarction.
- The findings suggest that CABG may be a preferred revascularization strategy for diabetic patients with NSTEMI, associated with reduced long-term mortality.
- Further research may explore patient-specific factors influencing the choice between CABG and PCI in this vulnerable population.
Objective:
To compare the outcomes of diabetic patients hospitalized with non-ST-elevation myocardial infarction (NSTEMI) referred for coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in a real-world evidence population.
Patients And Methods:
This study assessed major cardiovascular outcomes in diabetic patients who underwent myocardial revascularization, using data obtained on July 24, 2024, from TriNetX, a global health research network. Patients with diabetes mellitus and NSTEMI were identified using the International Classification of Diseases, Tenth Revision, diagnosis code. Main outcome measure was 5-year all-cause mortality. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patients.
Results:
A total of 18,115 patients with a mean age of 62.2 (SD, 8.98) years and a mean glycated hemoglobin A1c of 7.66% (SD, 2.18%) were included, of whom 8206 (45.3%) underwent CABG and 9909 (54.7%) underwent PCI. During the 5-year follow-up, 2275 (12.5%) deaths were recorded in all cohort. Propensity matching yielded a 1:1 match consisting of 7585 patients in each group (CABG vs PCI); CABG was associated with significantly lower all-cause mortality over 5 years of follow-up (10.6% vs 17.9%; hazard ratio, 0.685; 95% CI, 0.618-0.759; P<.0001). Myocardial infarction occurred more frequently in the PCI cohort (48.6% vs 43.3%; P<.0001). Additional coronary revascularization was higher for PCI patients at 5 years (14.5% vs 1.72%; P=.0229).
Conclusion:
In this real-world study of diabetic patients with NSTEMI, CABG was associated with a lower rate of all-cause mortality at 5 years when compared with PCI.
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