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PCI, CABG outcomes comparable among patients with, without diabetes

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There was no difference in mortality and serious outcomes between PCI and CABG for the treatment of multivessel or left main CAD among patients with or without diabetes, although PCI was associated with a higher risk for repeat revascularization, according to study results.

Researchers performed a pooled analysis of 5,775 patients with multivessel or left main CAD from three clinical studies and compared adverse outcomes among those with or without diabetes. Among the main cohort, 2,789 patients were treated with PCI and 2,986 were treated with CABG. In the cohort, 1,761 (31%) patients had medically treated diabetes. Among patients treated with PCI, 15% received bare-metal stents and 85% received drug-eluting stents.

During follow-up (median, 5.5 years), risk-adjusted mortality after PCI relative to CABG did not differ among patients with diabetes (HR=1.15; 95% CI, 0.88-1.51) compared with patients without diabetes (HR=1.15; 95% CI, 0.88-1.50). Adjusted risks of the composite outcome of death, Q-wave MI or stroke were also not different in patients with (HR=1.00; 95% CI, 0.79-1.26) or without (HR=0.99; 95% CI, 0.78-1.26) diabetes.

However, PCI was significantly associated with higher risk for repeat revascularization among patients with (HR=3.56; 95% CI, 2.62-4.83) and without (HR=3.55; 95% CI, 2.61-4.83) diabetes. There were no significant interactions between diabetes and revascularization strategies for death (P=.27), composite outcome of death, Q-wave MI or stroke (P=.97), and repeat revascularization (P=.08).

Researchers said the observational study is hypothesis-generating and randomized trials are needed to confirm results. However, combined cohorts can examine subsets that would other lack statistical power.

“Our data provide more precise estimates of the relative effect of revascularization strategies, according to diabetic status; as a result, diabetes mellitus does not modify the treatment effect of PCI or CABG on the long-term outcomes of patients with multivessel or left main CAD,” the researchers wrote.

For more information:

Park DW. Circ Cardiovasc Interv. 2012;5:467-475.