137 Management Choices and Outcomes of Multi-Vessel Coronary Artery Disease in Diabetics With Left Ventricular Systolic Dysfunction

Abstract

Guidelines recommend coronary artery bypass grafting(CABG) over percutaneous coronary intervention(PCI) for multivessel disease(MVD) in patients with diabetes and LV systolic dysfunction, however this is not often followed. We aim to predict factors that help determine treatment allocation & outcomes in this population. We compared outcomes in diabetics with MVD and LV dysfunction managed with either PCI, CABG or medical therapy between 2008 & 2018. Propensity weights were used to estimate treatment effects and derive relative risks. The primary outcome was composite of either death, myocardial infarction (MI), stroke or unplanned revascularisation. 235 patients were included. Mean age 67yrs (10.9), 83% male. The median STS score was 4.2(medical); 2.7(PCI) and 2(CABG). We found that FEV1, NYHA class, Clinical frailty score, left main disease, STS score, ejection fraction and heart team consensus predicted treatment allocation hence they were included in a model for probability of treatment. The CABG group had reduced deaths [RR 0.44(0.22,0.91) p=0.025] and MI [RR 0.29 (0.10. 0.83) p=0.022] at 5yrs compared with PCI with no differences in stroke and unplanned revascularisation. Apart from standard clinical factors; clinical frailty and heart team consensus play an important role in guiding treatment allocation. At 5yr follow-up, diabetics with MVD and LV systolic dysfunction treated with CABG exhibited a significantly lower incidence of MI and deaths over PCI, with no difference in stroke and unplanned revascularisation.