Comparing different revascularization approaches on the prognosis of elderly patients aged 75 and over with diabetes and multi-vessel coronary artery disease

Abstract

Objective To evaluate the clinical effects of two different revascularization approaches, one via percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and the other via coronary artery bypass graft (CABG), on short- and long-term prognosis in elderly patients with diabetes and multi-vessel coronary artery disease. Methods A retrospective analysis was conducted on 254 elderly patients with diabetes and multi-vessel coronary artery disease. Based on the revascularization approach, patients were divided into the PCI group (n=93) and the CABG group (n=161). The incidence of major cardiovascular events (MACE) were observed during hospitalization and 1-year after follow-up. Results All - cause mortality and the incidence of non-fatal myocardial infarction were higher in the CABG group than in the PCI group during hospitalization 〔4.9% (8 cases) vs.1.1% (1 cases), 5.6% (9 cases) vs. 2.2% (2 cases), each P 0.05). The incidence of cerebrovascular events was lower in the PCI group than in the CABG group〔2.2 % (2 cases) vs.6.2% (10 cases), P<0.05〕, while the rate of revascularization was higher in the PCI group than in the CABG group 〔6.5% (6 cases) vs.1.9% (3 cases), P<0.05〕. Cox regression analysis showed that diabetes (OR=1.65, 95%CI: 1.013-1.926, P=0.024) and left ventricular ejection fraction (OR=1.30, 95%CI: 1.018-1.652, P=0.027) were independent risk factors for revascularization and cerebrovascular events. Conclusions MACEs during hospitalization are fewer in elderly patients with diabetes and multi-vessel coronary artery heart disease who received PCI than in those who received CABG. PCI has a similar mid- and long- term effect as CABG, but PCI has a higher revascularization rate and lower risk of MACEs than CABG. Key words: Angioplasty, transluminal, percutaneous coronary; Coronary artery bypass; Diabete mellitus