April 6, 2020BMC Cardiovascular DisordersOpen Access

Percutaneous coronary intervention in diabetic versus non-diabetic patients with prior coronary artery bypass grafting: a propensity score matching study

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Why the study?

The study explored the outcomes of percutaneous coronary intervention in diabetic versus non-diabetic patients with prior coronary artery bypass grafting surgery.

Does diabetes mellitus worsen clinical outcomes in patients with prior CABG undergoing PCI with DES?

Structured PICO

Does diabetes mellitus worsen clinical outcomes in patients with prior CABG undergoing PCI with DES?

Population

724 patients who had previously received coronary artery bypass grafting (CABG) and were treated using percutaneous coronary intervention (PCI) combined with drug-eluting stents (DES) between 2009 and 2017.

Intervention

Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with diabetes mellitus

Comparator

Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients without diabetes mellitus

Outcome

Composite of cardiac death, myocardial infarction, heart failure and revascularization (overall MACEs)composite

In patients with prior CABG undergoing PCI with DES, clinical outcomes were similar between diabetic and non-diabetic patients over a median follow-up of 5.13 years.

Implication

Comparable MACE rates suggest diabetes may not worsen prognosis after post-CABG PCI; leaves open independent effect pending randomized confirmation.

Abstract

BACKGROUND: The target of this study was to explore the outcomes of percutaneous coronary intervention (PCI) in diabetic versus non-diabetic patients with prior coronary artery bypass grafting (CABG) surgery. METHODS: Seven hundred and twenty four patients who had previously received CABG and had been treated using PCI combined with drug-eluting stents (DES) between 2009 and 2017 were selected for a retrospective study and allocated into either a diabetes mellitus (DM) or non-diabetes mellitus (No DM) group. A 1:1 propensity score-matched evaluation was conducted and risk adjusted for analysis. The primary outcomes were cardiac death, myocardial infarction, heart failure and revascularization, with a median follow-up duration of 5.13 years. RESULTS: After matching, two-, 5- and 8-year event rate of overall major adverse cardiac events (MACEs) were found to be higher in the DM group (No DM vs DM:15.3, 30.9, 38.5% vs 19.8, 37.8, 52.2%, respectively), although no significant difference was found in the event rate of overall MACEs (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.00 to 1.83 for DM vs No DM; P = 0.052), cardiac death (HR: 0.94; 95% CI: 0.45 to 1.95; P = 0.871), MI (HR: 1.49; 95% CI: 0.95 to 2.32; P = 0.080), HF (HR: 1.54; 95% CI: 0.90 to 2.63 for; P = 0.120) or revascularization (HR: 1.07; 95% CI: 0.72 to 1.59; P = 0.747). Subgroup analysis of PCI in only the NCA showed MACEs (adjusted HR: 1.13; 95% CI: 0.85 to 1.49 for DM vs No DM; P = 0.325), cardiac death (adjusted HR: 0.85; 95% CI: 0.41 to 1.78 for DM vs No DM; P = 0.781), MI (adjusted HR: 1.32; 95% CI: 0.84 to 2.01 for DM vs No DM; P = 0.069), HF (adjusted HR: 1.41; 95% CI: 0.87 to 2.27 for DM vs No DM; P = 0.211) or repeated revascularization (adjusted HR: 0.93; 95% CI: 0.64 to 1.37 for DM vs No DM; P = 0.836). CONCLUSIONS: Compared with non-diabetic patients with prior CABG, subsequent implantation of DES in the native coronary artery of diabetic patients resulted in apparently similar outcomes. TRIAL REGISTRATION: This study was not registered in an open access database.