Improved Outcomes With CABG vs PCI for Diabetes With LV Dysfunction

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PCI may be associated with an increased risk for MACCE compared with CABG in patients with diabetes and LV dysfunction.
PCI may be associated with an increased risk for MACCE compared with CABG in patients with diabetes and LV dysfunction.

Coronary artery bypass grafting (CABG) results in better outcomes for patients with diabetes, coronary artery disease, and left ventricular dysfunction compared with percutaneous coronary intervention (PCI), according to results published in the Journal of the American College of Cardiology.

Patients undergoing CABG had significantly lower rates of major adverse cardiac and cerebrovascular events, as well as higher rates of long-term survival, compared with patients treated with PCI.

The study assessed outcomes for patients with multivessel coronary artery disease, diabetes mellitus, and left ventricular dysfunction who were treated with either PCI or CABG between 2004 and 2016. 

The primary outcome was major adverse cardiac and cerebrovascular events, defined as the composite of death, stroke, myocardial infarction, and repeat revascularization. Secondary outcomes were the individual components of the primary outcome.

Patients treated with PCI had a higher risk for major adverse cardiac and cerebrovascular events in cohorts with ejection fraction (EF) 35% to 49% (P <.001) and <35% (P <.001). Both EF cohorts had an increased risk for death when treated with PCI.

Patients with EF <35% had an increased rate of myocardial infarction when treated with PCI compared with CABG. Patients in both EF cohorts had increased rates of repeat revascularization with PCI compared with those in the CABG group.

The rate of stroke did not differ for patients treated with PCI compared with those treated with CABG.

"This study provides the first data to suggest that patients who have [coronary artery disease, diabetes, and left ventricular dysfunction] benefit from CABG, as it offers a long-term overall survival benefit, reduced risk for [myocardial infarction,] and repeat revascularization, and no increased rate of stroke compared with PCI for this subgroup of patients," the study authors concluded.

Reference

Nagendran J, Bozso SJ, Norris CM, et al. Coronary artery bypass surgery improves outcomes in patients with diabetes and left ventricular dysfunction. J Am Coll Cardiol. 2018;71(8):819-827.

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