Key result
Coronary artery bypass grafting reduced patient-defined adverse cardiovascular and non-cardiovascular events by 12% at 1 year and 17% at 5 years compared to percutaneous coronary intervention in diabetic patients with severe coronary artery disease.
Why the study?
While CABG confers a long-term survival advantage over PCI in patients with diabetes and CAD, there is a knowledge gap regarding patient-centered outcomes.
Does CABG reduce patient-defined adverse cardiovascular and non-cardiovascular events (PACE) in diabetic patients with severe CAD compared to PCI?
Observational (n=58,826)
Yes
Does CABG reduce patient-defined adverse cardiovascular and non-cardiovascular events (PACE) in diabetic patients with severe CAD compared to PCI?
Answers are grounded in this paper and cite their sources.
In diabetic patients with severe coronary artery disease, CABG is associated with lower rates of patient-defined adverse events and all-cause mortality within the first five years compared to PCI.
Abstract Background In patients with diabetes and coronary artery disease (CAD), coronary artery bypass grafting (CABG) confers long-term survival advantage over percutaneous coronary intervention (PCI); however, there is a knowledge gap regarding patient-centered outcomes. We therefore compared patient-defined adverse cardiovascular and non-cardiovascular events (PACE) after CABG versus PCI in diabetic patients. Methods We conducted a population-based, retrospective cohort study of all diabetic patients who underwent CABG or PCI between October 2008 and December 2018 in Ontario, Canada. The primary outcome was PACE, defined as the composite of severe stroke requiring hospitalization >14 days or inpatient rehabilitation, ventilator dependence, heart failure hospitalization, long-term care admission, and new-onset dialysis. Secondary outcomes included all-cause mortality and individual PACE components. Overlap weighting using propensity scores was performed to account for baseline differences between groups. Cumulative incidence functions were estimated and groups were compared using cause-specific hazard models (with death as a competing risk) and Cox proportional hazards models. Results 58,826 patients (25,751 CABG; 33,075 PCI) were followed for a mean (SD) of 4.7 (3.1) (maximum 11.5) years. Rates of PACE were lower after CABG versus PCI over 1-5 years post-intervention (1-year HR 0.88 [0.77-1.00]; 5-year HR 0.83 [0.71-0.97]). Rates of death were lower after CABG during the first 8 years (30-day HR 0.61 [0.50-0.74]; 5-year HR 0.71 [0.63-0.80]; 8-year HR 0.82 [0.69-0.98]). Conclusions We observed lower rates of PACE and all-cause mortality in diabetic patients within the first five years after CABG compared to PCI. Findings could be used to inform shared decision-making to achieve outcomes most valued by patients.
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Vervoort et al. (2026) conducted an observational in Adult diabetic patients aged 40-85 with severe multivessel, left anterior descending (LAD), or left main coronary artery disease undergoing coronary revascularization (n=58,826). Coronary artery bypass grafting (CABG) vs. Percutaneous coronary intervention (PCI) was evaluated on Patient-defined adverse cardiovascular and non-cardiovascular events (PACE) composite including severe stroke requiring hospitalization >14 days or inpatient rehabilitation, ventilator dependence, heart failure hospitalization, long-term care admission, and new-onset dialysis (HR 0.88 at 1 year, HR 0.83 at 5 years, 95% CI 1-year HR 0.77-1.00; 5-year HR 0.71-0.97). Coronary artery bypass grafting reduced patient-defined adverse cardiovascular and non-cardiovascular events by 12% at 1 year and 17% at 5 years compared to percutaneous coronary intervention in diabetic patients with severe coronary artery disease.
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