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Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty
G W Barsness1, E D Peterson, E M Ohman
1Duke Heart Center, Duke University Medical Center, Durham, NC, USA. barsn001@onyx.mc.duke.edu
Insights
Diabetes worsens survival after coronary revascularization, whether by percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG). However, the negative impact of diabetes is similar for both procedures in multivessel coronary artery disease patients.
Area of Science:
- Cardiology
- Diabetology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Subgroup analyses suggest higher mortality with percutaneous intervention versus coronary artery bypass graft surgery (CABG) in diabetic patients with multivessel disease.
- The relationship between diabetes and survival after revascularization in multivessel coronary artery disease requires further investigation in large prospective cohorts.
Purpose of the Study:
- To investigate the impact of diabetes on long-term survival after revascularization in patients with multivessel coronary artery disease.
- To compare the outcomes of percutaneous transluminal coronary angioplasty (PTCA) versus CABG in diabetic and non-diabetic patients with multivessel coronary artery disease.
Main Methods:
- Prospective cohort study of 3220 patients with symptomatic two- or three-vessel coronary disease.
- Patients underwent either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG) between 1984 and 1990.
- Survival rates at 5 years were analyzed, with adjustments for baseline characteristics.
Main Results:
- Diabetic patients (24% of cohort) had significantly poorer survival at 5 years compared to non-diabetic patients, regardless of treatment (PTCA or CABG).
- Unadjusted 5-year survival was 74% for diabetics undergoing CABG vs. 86% for non-diabetics; for PTCA, it was 76% for diabetics vs. 88% for non-diabetics.
- No significant difference in the effect of diabetes on outcome was observed between PTCA and CABG treatment groups.
Conclusions:
- Diabetes is associated with worse long-term outcomes following both PTCA and CABG in patients with multivessel coronary artery disease.
- The prognostic impact of diabetes is similar for both revascularization strategies.
- Treatment decisions should consider factors beyond diabetes, including angiographic suitability and clinical status.
Background:
Recent subgroup analyses of randomized trials have suggested that percutaneous intervention in diabetic patients with multivessel disease results in higher mortality than coronary artery bypass graft surgery (CABG). We studied the relationship between diabetes and survival after revascularization in a large prospective cohort of patients with multivessel coronary artery disease.
Methods And Results:
By analyzing data for 3220 patients (24% diabetic) with symptomatic two- or three-vessel coronary disease who were undergoing percutaneous transluminal coronary angioplasty (PTCA) or CABG at Duke University Medical Center between 1984 and 1990, we found that at 5 years, unadjusted survival in the group of patients undergoing CABG was 74% in diabetics and 86% in nondiabetics. Similarly, 5-year survival among PTCA patients was 76% in diabetics and 88% in patients without diabetes. After adjustment for baseline characteristics, diabetic patients receiving either PTCA or CABG had significantly poorer survival than nondiabetics (chi2=43.56, P<.0001). Unlike previous studies, however, there was no significant differential effect of diabetes on outcome between patients treated with PTCA and those treated with CABG (chi2=0.01, P=.91).
Conclusions:
Although diabetes was associated with a worse long-term outcome after both PTCA and CABG in patients with multivessel coronary artery disease, the effect of diabetes on prognosis was similar in both treatment groups. Thus, our findings support the concept that the choice of initial revascularization strategy should not be based exclusively on a history of diabetes but rather should rely on other factors, such as angiographic suitability and clinical status.
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