Data of this “real world” study have confirmed that diabetic patients with multivessel disease will benefit from coronary artery bypass grafting (CABG).
According to Dr. Douglas S. Lee, main author of this study, the evidence is fairly conclusive, enough to recommend CABG as first option in this particular subgroup of patients similar to FREEDOM patients.
In the FREEDOM, CABG kept its advantage against PCI in terms of mortality at 8 years. Criticism involved significant patient loss at followup, and the use of obsolete stents.
In this real-life registry, we also find limitations. In fact, nearly 25% of patients received conventional stents.
Not only did stent technology advance during these years, but also medical therapy. Each study we look at, regardless how recent, has included patients with different treatment standards to the ones we use today. The longer the followup, the greater the gap between protocol treatment and the current treatment.
The registry included nearly 15000 diabetic patients, retrospectively, with angiographic evidence of stenosis in 2 or 3 vessels, undergoing PCI (n=4519) or CABG (n=9716) between 2008 and 2017.
Propensity scored matched 4301 pairs with identical baseline characteristics.
Mortality at 30 days resulted practically identical (2.4% vs 2.3%; p=0.721) as did stroke and infarction rates.
At 5.5-year followup, all-cause mortality (primary end point) resulted higher in the PCI group vs. the CABG group (HR 1.39; CI 95% 1.28-1.51).
The combined end point (MI, repeat revascularization, stroke and death) also resulted significantly lower with surgery (HR 1.99; 95% CI 1.86-2.12).
At long term, there were differences in MI and repeat revascularization rates, but not in stroke rate.
Secondary subgroup analyzis of cases with left main lesions, or the subgroup with conventional stents showed similar results.
Original Title: Long-term survival after surgical or percutaneous revascularization in patients with diabetes and multivessel coronary disease.
Reference: Tam DY et al. J Am Coll Cardiol. 2020;76:1153-1164 y presentado en forma virtual en el ESC 2020.
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