Key result
CABG linked to ~35% lower 10-year mortality vs PCI in diabetic NSTEMI or unstable angina patients.
Why the study?
The study was conducted to compare outcomes in a real-life setting between CABG and PCI among diabetic patients hospitalized with NSTEMI or unstable angina.
Does coronary artery bypass grafting improve long-term survival compared to percutaneous coronary intervention in diabetic patients presenting with non-ST elevation acute coronary syndrome?
Cohort (n=1,987)
Yes
Does coronary artery bypass grafting improve long-term survival compared to percutaneous coronary intervention in diabetic patients presenting with non-ST elevation acute coronary syndrome?
Effect estimate: HR 1.53 (PCI vs CABG) (95% CI 1.07-2.21)
Absolute Event Rate: 27% vs 36%
p-value: p=0.021
In diabetic patients presenting with NSTEMI or unstable angina, revascularization by CABG is associated with a significant long-term survival benefit compared to PCI, with the advantage emerging after 2 years.
May support CABG preference for long-term survival in diabetic NSTE-ACS; leaves open need for randomized confirmation.
BACKGROUND: To compare the outcomes of diabetic patients hospitalized with non-ST elevation myocardial infarction (NSTEMI) or unstable angina (UA) referred for revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in a real-life setting. METHODS: The study included 1987 patients with diabetes mellitus enrolled from the biennial Acute Coronary Syndrome Israeli Survey between 2000 and 2016, who were hospitalized for NSTEMI or UA, and underwent either PCI (N = 1652, 83%) or CABG (N = 335, 17%). Propensity score-matching analysis compared all-cause mortality in 200 pairs (1:1) who underwent revascularization by either PCI or CABG. RESULTS: Independent predictors for CABG referral included 3-vessel coronary artery disease (OR 4.9, 95% CI 3.6-6.8, p < 0.001), absence of on-site cardiac surgery (OR 1.4, 95% CI 1.1-1.9, p = 0.013), no previous PCI (OR 1.5, 95% CI 1.1-2.2, p = 0.024) or MI (OR 1.7, 95% CI 1.2-2.6, p = 0.002). While at 2 years of follow-up, survival analysis revealed no differences in mortality risk between the surgical and percutaneous revascularization groups (log-rank p = 0.996), after 2 years CABG was associated with a significant survival benefit (HR 1.53, 95% CI 1.07-2.21; p = 0.021). Comparison of the propensity score matching pairs also revealed a consistent long-term advantage toward CABG (log-rank p = 0.031). CONCLUSIONS: In a real-life setting, revascularization by CABG of diabetic patients hospitalized with NSTEMI/UA is associated with better long-term outcomes. Prospective randomized studies are warranted in order to provide more effective recommendations in future guidelines.
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Ram et al. (2022) conducted a cohort in Diabetes mellitus with non-ST elevation myocardial infarction (NSTEMI) or unstable angina (UA) (n=1,987). Coronary artery bypass grafting (CABG) vs. Percutaneous coronary intervention (PCI) was evaluated on 10-year all-cause mortality (HR 1.53 (PCI vs CABG), 95% CI 1.07-2.21, p=0.021). In diabetic patients presenting with NSTEMI or unstable angina, coronary artery bypass grafting was associated with a 35% reduction in the risk of 10-year mortality compared with percutaneous coronary intervention.
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