Six-Year Outcomes of CABG vs PCI in Diabetic Patients with Multivessel Coronary Disease

BACKGROUND Many randomized controlled trials have explored the optimal revascularization strategy for patients with diabetes, but real-life outcomes are still poorly investigated. We assessed the complete 6-year outcomes of diabetic individuals with multivessel coronary artery disease (MVD) treated either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). MATERIAL AND METHODS We reviewed data of all patients from 176 local Heart Team meetings and their treatment recommendations and assessed primary and secondary endpoints of 317 MVD patients with diabetes qualified either for CABG or PCI (98 and 219 patients, respectively) with subsequent optimal medical therapy. RESULTS At 6 years, no significant difference in overall mortality was observed (16.3% vs 20.5% for PCI, P=0.38). The incidence of myocardial infarction (MI) was higher in patients treated percutaneously (4.1% vs 12.3% for PCI, P=0.02), while those undergoing CABG had significantly longer postprocedural hospital stay (10.7 vs 4.4 days for PCI, P<0.01). The occurrence of major adverse cardiac and cerebrovascular events (MACCE), mainly driven by the increased rate of repeat revascularization (RR), was higher in the PCI group (83.6% vs 44.9%, P<0.01 and 47.0% vs 17.3%, P<0.01, respectively). The rates of stroke and in-hospital mortality were similar between the 2 groups. CONCLUSIONS For MVD patients with diabetes, CABG was superior in real-life clinical practice in terms of rates of MI, RR, and MACCE, while postprocedural hospital stays were shorted with PCI. The rates of all-cause death, stroke, and in-hospital mortality were comparable between groups.