CABG outperforms PCI in diabetics with multivessel disease

Coronary artery bypass graft (CABG) leads to better long-term survival than percutaneous coronary intervention (PCI) in unselected type 2 diabetes patients, a recent study has found.

Researchers enrolled 430 diabetes mellitus patients with multivessel disease determined through angiographic screening. At a median of 6 years, the overall rate for all-cause mortality was 25 percent. This was significantly greater in those who underwent CABG vs PCI or who had no revascularization (16 percent vs 26 percent and 33 percent; p=0.009).

Those who received CABG also had the lowest rate of nonfatal myocardial infarction relative to other procedures (p=0.016). The same was true for the composite endpoint of death, stroke and myocardial infarction (p<0.001).

Multivariable analysis further showed that not undergoing CABG was a significant risk factor for late mortality, as were older age and hypertension. In comparison, presenting with acute coronary syndrome and triple vessel disease were significantly associated with greater risks of late myocardial infarction.

The composite endpoint, on the other hand, was correlated triple vessel disease, acute coronary syndrome and not undergoing any revascularization procedures.

Subsequent propensity analyses found that those treated with PCI showed significantly higher rates of mortality (hazard ratio [HR], 1.94, 95 percent CI, 1.02–3.70; p=0.045), myocardial infarction (HR, 2.87, 1.12–7.31; p=0.028) and of the composite outcome (HR, 1.80, 1.11–2.92; p=0.017) than their CABG counterparts. These trends held up in multivariable Cox regression analysis.