Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Diabetes and Multivessel Coronary Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:76

Article

Tam, Derrick Y.^1,2  Dharma, Christoffer³  Rocha, Rodolfo⁴  Farkouh, Michael E.⁵  Abdel-Qadir, Husam^2,3,6  Sun, Louise Y.^7,8,9  Wijeysundera, Harindra C.^2,10  Austin, Peter C.³  Udell, Jacob A.^2,3,5,6  Gaudino, Mario¹¹  Fremes, Stephen E.¹  Lee, Douglas S.^2,3,5 

[1] Univ Toronto, Sunnybrook Hlth Sci Ctr, Schulich Heart Ctr, Div Cardiac Surg,Dept Surg, Toronto, ON, Canada

[2] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[3] ICES, Toronto, ON, Canada

[4] Univ Toronto, Univ Hlth Network, Peter Munk Cardiac Ctr, Div Cardiac Surg,Dept Surg, Toronto, ON, Canada

[5] Univ Toronto, Univ Hlth Network, Peter Munk Cardiac Ctr, Div Cardiol,Dept Med, Toronto, ON, Canada

[6] Univ Toronto, Womens Coll Hosp, Dept Med, Div Cardiol, Toronto, ON, Canada

[7] Univ Ottawa, Heart Inst, Dept Anesthesiol & Pain Med, Ottawa, ON, Canada

[8] ICES, Ottawa, ON, Canada

[9] Univ Ottawa, Sch Epidemiol & Publ Hlth, Ottawa, ON, Canada

[10] Univ Toronto, Schulich Heart Ctr, Div Cardiol, Dept Med, Toronto, ON, Canada

[11] Weill Cornell Med Coll, Dept Cardiothorac Surg, New York, NY USA

关键词: coronary artery bypass grafting;    diabetes;    percutaneous coronary intervention;    propensity score;   

DOI  :  10.1016/j.jacc.2020.06.052

来源: Elsevier

【 摘 要 】

BACKGROUND There remains a paucity of real-world observational evidence comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with diabetes and multivessel coronary artery disease (CAD). OBJECTIVES This study compared early and tong-term outcomes of PCI versus CABG in patients with diabetes. METHODS Clinical and administrative databases M Ontario, Canada were linked to obtain records of all patients with diabetes with angiographic evidence of 2- or 3-vessel CAD who were treated with either PCI or isolated CABG from 2008 to 2017. A 1:1 propensity score match was performed to account for baseline differences. Alt-cause mortality and the composite of myocardial infarction, repeat revascularization, stroke, or death (termed major cardiovascular and cerebrovascutar events [MACCEs]) were compared between the matched groups using a stratified log-rank test and Cox proportional hazards model. RESULTS A total of 4,519 and 9,716 patients underwent PCI and CABG, respectively. Before matching, patients who underwent CABG were significantly younger (age 65.7 years vs. 68.3 years), were more likely to be men (78% vs. 73%) and had more severe CAD. Propensity score matching based on 23 baseline covariates yielded 4301 well-balanced pairs. There was no difference in early mortality between PCI and CABG (2.4% vs. 2.3%; p = 0.721) after matching. The median and maximum follow-ups were 5.5 and 11.5 years, respectively. All-cause mortality (hazard ratio [HR]: 1.39; 95% CI: 1.28 to 1.51) and overall MACCEs (HR: 1.99; 95% CI: 1.86 to 2.12) were significantly higher with PCI compared with CABG. CONCLUSIONS In patients with multivesset CAD and diabetes, CABG was associated with improved long-term mortality and freedom from MACCEs compared with PCI. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

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