Coronary artery bypass grafting (CABG) was associated with improved long-term mortality and freedom from major cardiovascular and cerebrovascular events (MACCEs) compared with percutaneous coronary intervention (PCI) in patients with diabetes, according to results of a study published in the Journal of the American College of Cardiology.
Although randomized clinical trials have demonstrated a mortality benefit and reduced risk of nonfatal myocardial infarction after CABG compared with PCI for individuals with diabetes and multivessel coronary artery disease (CAD), their comparative effectiveness in real-world practice has not yet been evaluated.
To compare long-term mortality and MACCEs at the population level between PCI vs CABG in patients with diabetes and multivessel CAD, data from 14,235 patients were analyzed. Patients who underwent revascularization with CABG or PCI within 90 days of an invasive coronary angiography were included. Patients were matched on 23 baseline covariates with standardized mean differences of <0.10 for all covariates (n=4301 in both CABG and PCI groups).
After an average of 8 years, all-cause mortality (hazard ratio [HR], 1.39; 95% CI, 1.28-1.51; P <.0001) and overall MACCEs (HR, 1.99; 95% CI, 1.86-2.12; P <.0001) were significantly higher in patients who underwent PCI compared with CABG. The cumulative incidence of myocardial infarctions was significantly higher in patients who underwent PCI compared with CABG (HR, 2.32; 95% CI, 2.04-2.64, P <.001). The risk of revascularization was >3-fold higher in the PCI group than in CABG (sub-distribution HR, 3.65; 95% CI, 3.24-4.34; P <.001).
The results of this study suggested that revascularization with CABG may be the preferred approach for individuals with diabetes and multivessel CAD. These findings were consistent with randomized clinical trials previously conducted.
Limitations to this study include its retrospective observational study design, which may be subject to treatment allocation bias. Although extensive matching of patients was performed, there may be unknown covariates that were not taken into consideration.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Tam DY, Dharma C, Rocha R, et al. Long-term survival after surgical or percutaneous revascularization in patients with diabetes and multivessel coronary disease. J Am Coll Cardiol. 2020;76(10):1153-1164.