Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction

Objective To compare the outcomes of diabetic patients hospitalized with non–ST-elevation myocardial infarction (NSTEMI) referred for coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in a real-world evidence population. Patients and Methods This study assessed major cardiovascular outcomes in diabetic patients who underwent myocardial revascularization, using data obtained on July 24, 2024, from TriNetX, a global health research network. Patients with diabetes mellitus and NSTEMI were identified using the International Classification of Diseases, Tenth Revision, diagnosis code. Main outcome measure was 5-year all-cause mortality. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patients. Results A total of 18,115 patients with a mean age of 62.2 (SD, 8.98) years and a mean glycated hemoglobin A1c of 7.66% (SD, 2.18%) were included, of whom 8206 (45.3%) underwent CABG and 9909 (54.7%) underwent PCI. During the 5-year follow-up, 2275 (12.5%) deaths were recorded in all cohort. Propensity matching yielded a 1:1 match consisting of 7585 patients in each group (CABG vs PCI); CABG was associated with significantly lower all-cause mortality over 5 years of follow-up (10.6% vs 17.9%; hazard ratio, 0.685; 95% CI, 0.618-0.759; P <.0001). Myocardial infarction occurred more frequently in the PCI cohort (48.6% vs 43.3%; P <.0001). Additional coronary revascularization was higher for PCI patients at 5 years (14.5% vs 1.72%; P =.0229). Conclusion In this real-world study of diabetic patients with NSTEMI, CABG was associated with a lower rate of all-cause mortality at 5 years when compared with PCI.