Abstract
Background: The best treatment for coronary artery disease (CAD) in patients with type 2 diabetes (DM2) and chronic kidney disease is unknown.Methods: This retrospective study included MASS registry patients with DM2 and multivessel CAD, stratified by kidney function. Primary endpoint was combined of mortality, myocardial infarction, or additional revascularization.Results: Median follow-up was 9.5 years. Primary endpoint occurrences among strata 1 and 2 were 53.4% and 40.7%, respectively (P=.020). Mortality rates were 37.4% and 24.6% in strata 1 and 2, respectively (P<.001). We observed a lower rate of major adverse cardiovascular events (MACE) (P=.027 for stratum 1 and P<.001 for stratum 2) and additional revascularization (P=.001 for stratum 1 and P<.001 for stratum 2) for those in the surgical group. In a multivariate analysis, eGFR was an independent predictor of MACE (P=.034) and mortality (P=.020).Conclusions: Among subjects with DM2 and CAD the presence of lower eGFR rate was associated with higher rates of MACE and mortality, irrespective of treatment choice. CABG was associated with lower rates of MACE in both renal function strata. eGFR was an independent predictor of MACE and mortality in a 10-year follow-up.
Highlights
Type 2 diabetes mellitus is a highly prevalent disease and is associated with macro and microvascular involvement [1]
The objective of this study was to compare very long-term outcomes among diabetic patients with stable coronary artery disease (CAD), stratified according to their renal function, who were enrolled in the MASS registry and underwent coronary artery bypass www.aging-us.com graft (CABG), percutaneous coronary intervention (PCI), or medical therapy (MT)
Patients were divided into 2 strata of renal function according to estimated glomerular filtration rate (eGFR)
Summary
Type 2 diabetes mellitus is a highly prevalent disease and is associated with macro and microvascular involvement [1]. The association between type 2 diabetes and kidney disease is widely recognized and increases through age [3]. Even after adjusting for demographic variables, 24% of the population with chronic kidney disease (CKD) had type 2 diabetes as the main etiology. The best treatment for coronary artery disease (CAD) in patients with type 2 diabetes (DM2) and chronic kidney disease is unknown. Conclusions: Among subjects with DM2 and CAD the presence of lower eGFR rate was associated with higher rates of MACE and mortality, irrespective of treatment choice. CABG was associated with lower rates of MACE in both renal function strata. EGFR was an independent predictor of MACE and mortality in a 10-year follow-up CABG was associated with lower rates of MACE in both renal function strata. eGFR was an independent predictor of MACE and mortality in a 10-year follow-up
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