Abstract
BackgroundPatients with diabetes and triple-vessel disease (TVD) are associated with a high risk of events. The choice of treatment strategies remains a subject of discussion. In the real-world, we aim to compare the outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) treatment strategies in patients with diabetes and TVD.MethodsA total of 3117 consecutive patients with diabetes and TVD were enrolled. The primary endpoint was all-cause death and the secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, or stroke).ResultsDuring the mean follow-up of 6.3 ± 2.6 years, 573 (18.4%) deaths and 1094 (35.1%) MACCE occurred. Multivariate analysis showed that PCI (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.32–0.51) and CABG (HR 0.33, 95% CI 0.26–0.44) were associated with a lower risk of death compared with MT, with no difference between the PCI and CABG groups. When MACCE was the endpoint, PCI (HR 0.71, 95% CI 0.60–0.84) and CABG (HR 0.48, 95% CI 0.39–0.57) had a lower risk than MT. CABG was associated with a significantly lower risk of MACCE compared with PCI (HR 0.67, 95% CI 0.55–0.81), which was mainly attributed a lower risk in myocardial infarction, but a higher risk of stroke.ConclusionsIn this big real-world data and intermediate-term follow-up study, for patients with diabetes and TVD, PCI and CABG were associated with a lower risk of death and MACCE more than MT. The results suggest the importance of appropriate revascularization for diabetic patients with TVD. However, CABG was not associated with a lower risk of death, but with a lower risk of MACCE, compared with PCI. In the future, we perhaps should strengthen comprehensive treatment in addition to PCI or CABG.
Highlights
Patients with diabetes and triple-vessel disease (TVD) are associated with a high risk of events
In patients with a SYNTAX score of 23–32, percutaneous coronary intervention (PCI) (HR 0.63, 95% Confidence interval (CI) 0.48–0.83) and coronary artery bypass grafting (CABG) (HR 0.45, 95% CI 0.33–0.61) were associated with a lower risk of major adverse cardiac and cerebrovascular events (MACCE) compared with medical therapy (MT)
In patients with a SYNTAX score of ≥ 33, PCI (HR 0.57, 95% CI 0.39–0.84) and CABG (HR 0.47, 95% CI 0.34–0.64) were still associated with a lower risk of MACCE compared with MT
Summary
Patients with diabetes and triple-vessel disease (TVD) are associated with a high risk of events. In the real-world, we aim to compare the outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) treatment strategies in patients with diabetes and TVD. Patients with multi-vessel coronary artery disease (MVD) and diabetes mellitus often have diffuse atherosclerosis and high risk of cardiovascular events [1, 2]. The choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in diabetic patients with triple-vessel coronary artery disease (TVD) remains a subject of intense discussion and debate. It is worth noting that the results of the recent 10-year Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) study [10] showed no difference in all-cause death between PCI and CABG
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