Percutaneous coronary intervention was associated with a higher 3-year risk of all-cause death compared to coronary artery bypass grafting in diabetic patients (HR 1.30; 95% CI 1.22-1.38).
Cohort (n=139,242)
Yes
Does percutaneous coronary intervention compared to coronary artery bypass grafting improve outcomes in diabetic and non-diabetic patients with coronary heart disease?
While PCI is associated with better short-term (28-day) survival, CABG offers superior long-term (3-year) prognosis, particularly for diabetic patients.
Effect estimate: HR 1.30 (95% CI 1.22-1.38)
AIMS: To assess the prognosis of patients with coronary heart disease (CHD) after first myocardial revascularisation procedure in real-world practice and to compare the differences in outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) among diabetic and non-diabetic patients. METHODS AND RESULTS: A database was compiled from the national hospital discharge register to collect data on all cardiac revascularisations performed in Finland in 2000-2015. The outcomes (all-cause deaths, cardiovascular (CV) deaths, major CV events and need for repeat revascularisation) after the first revascularisation were identified from the national registers at 28 day, 1 year, and 3 year time points.A total of 139 242 first-time revascularisations (89 493 PCI and 49 749 CABG) were performed during the study period. Of all the revascularised patients, 24% had diabetes, and 76% were non-diabetic patients. At day 28, the risk of fatal outcomes was lower after PCI than after CABG among non-diabetic patients, whereas no difference was seen among diabetic patients. In long-term follow-up the situation was reversed with PCI showing higher risk compared with CABG for most of the outcomes. In particular, at 3 year follow-up the risk of all-cause deaths was elevated among diabetic patients HR 1.30 (95% CI 1.22-1.38) comparing PCI with CABG more than among non-diabetic patients HR 1.09 (1.04-1.15). The same was true for CV deaths HR 1.29 (1.20-1.38) among diabetic patients, and HR 1.03 (0.98-1.08) among non-diabetic patients. CONCLUSION: Although PCI was associated with better 28 day prognosis, CABG seemed to produce better long-term prognosis especially among diabetic patients.
Lehto et al. (Tue,) conducted a cohort in coronary heart disease (CHD) (n=139,242). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass grafting (CABG) was evaluated on All-cause deaths at 3 years in diabetic patients (HR 1.30, 95% CI 1.22-1.38). Percutaneous coronary intervention was associated with a higher 3-year risk of all-cause death compared to coronary artery bypass grafting in diabetic patients (HR 1.30; 95% CI 1.22-1.38).