Surgery vs. PCI in Diabetic Patients with Multivessel Disease

Original Title: Revascularization in diabetics with multivessel disease: a population-based evaluation of outcomes.
Presenter: Ramanathan K.

Real-world data support the role of CABG over PCI in diabetic patients with multivessel disease. However, PCI continues to be a common ­­­­­­option for this patient population, according to an analysis of 2 Canadian registries.

Sourcing data from 2 registries in British Columbia, researchers analyzed 4,819 patients: 2,888 PCI and 1,931 CABG procedures between October 2007 and January 2014 in patients with diabetes and multivessel disease.

The adjusted 30-day risks of most adverse events were lower with CABG, except for stroke risk, which was lower with PCI. However, all long-term endpoints through 5 years favored CABG over PCI.

When separating results by diagnosis, we can see greater benefit in terms of all-cause mortality, non-fatal infarction and stroke with CABG over PCI in patients with stabilized acute coronary syndrome (4.4% vs 8.3%; P < 0.01), vs. those with stable ischemic heart disease, at 30 days (1.5% vs 2.3%; P = .30; Pfor interaction< 0.01). The long term benefit of surgery over PCI (31 days-5 years) was similar for both diagnosis (P< .01 for both).