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CREDO-Kyoto: Better long-term outcomes with CABG vs. PCI, regardless of diabetes status
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At 5 years, patients with and without diabetes who had three-vessel and/or left main disease had better rates of cardiac death, MI and coronary revascularization after CABG compared with PCI.
The multicenter Japanese CREDO-Kyoto PCI/CABG Registry Cohort-2 included 15,939 patients with first coronary revascularization. The current analysis focused on 3,982 patients with three-vessel and/or left main disease; 1,998 had diabetes (PCI, n = 1,065; CABG, n = 933) and 1,984 did not have diabetes (PCI, n = 1,123; CABG, n = 861).
At 5 years, the cumulative incidence of all-cause mortality was higher for patients who underwent PCI compared with CABG. Among patients without diabetes, the 5-year cumulative incidence rate was 19.8% after PCI vs. 16.2% after CABG (P = .01). Among patients with diabetes, the 5-year cumulative incidence rate was 22.9% after PCI vs. 19% after CABG (P = .046). When the researchers adjusted for confounding factors, the increased mortality risk after PCI remained significant among patients with diabetes (P = .04), but was no longer significant among patients without diabetes (P = .29).
Compared with CABG, PCI was associated with higher adjusted risks for cardiac death (HR = 1.45; 95% CI, 1-2.51), MI (HR = 2.31; 95% CI, 1.31-4.08) and any coronary revascularization (HR = 3.7; 95% CI, 2.91-4.69) among patients with diabetes. A similar trend was observed in favor of CABG in the patients without diabetes (cardiac death: HR = 1.59; 95% CI, 1.01-2.51; MI: HR = 2.16; 95% CI, 1.2-3.87; any coronary revascularization: HR = 3.3; 95% CI, 2.55-4.25).
The researchers found no interaction between diabetes status and the effect of PCI vs. CABG for any clinical outcome.
“We believe registry data [are] also important to elucidate the impact of CABG in large-volume, real-world diabetic patients,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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