July 5, 2026European Heart Journal48 citationsOpen Access
View Full PaperTen-year all-cause death after percutaneous or surgical revascularization in diabetic patients with complex coronary artery disease
Key Result
In patients with complex coronary artery disease and diabetes, PCI and CABG resulted in similar rates of all-cause death at 10 years (36.4% vs. 34.5%; difference 1.9%, 95% CI -7.6% to 11.1%; P=0.551).
Key Points
- To compare rates of all-cause death at 10 years following CABG or PCI in patients with or without diabetes.
- Evaluation of 1800 patients from the SYNTAX trial with three-vessel disease or left main coronary artery disease
- Randomization to receive either PCI or CABG
- Examination of all-cause death at 10 years according to diabetic status and revascularization strategy.
- In diabetics, 10-year mortality was 36.4% for PCI vs. 34.5% for CABG (P=0.551).
- In insulin-treated diabetics, mortality was 47.9% with PCI and 39.6% with CABG (P=0.227).
- Overall, treatment effects of PCI and CABG on mortality were similar regardless of diabetes status.
Study Design
Type
RCT (n=1,800)
Structured PICO
Does percutaneous coronary intervention compared to coronary artery bypass grafting reduce 10-year all-cause death in patients with complex coronary artery disease and diabetes?
P
Population
1,800 patients with three-vessel disease and/or left main coronary artery disease followed for up to 10 years to evaluate survival based on diabetic status and revascularization strategy.
I
Intervention
Percutaneous coronary intervention (PCI)
C
Comparator
Coronary artery bypass grafting (CABG)
O
Outcome
All-cause death at 10 yearshard clinical
At 10 years, PCI and CABG showed similar rates of all-cause death in patients with complex coronary artery disease, irrespective of diabetic status, though CABG may offer a survival benefit in insulin-treated diabetics.
Main Result
Effect estimate: difference 1.9% (95% CI -7.6%, 11.1%)
Absolute Event Rate: 36.4% vs 34.5%
p-value: p=0.551
Abstract
AIMS: The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes. METHODS AND RESULTS: The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years 19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075, with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: -7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: -6.5%, 22.5%, P = 0.227). CONCLUSIONS: The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials. TRIAL REGISTRATION: SYNTAX: ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.