Key result
DES implantation was associated with a higher 3-year risk of major adverse cardiac events compared to CABG in diabetic patients, regardless of diabetes duration <5 years (HR 2.27) or ≥5 years (HR 3.73).
Why the study?
Does drug-eluting stent implantation compared to coronary artery bypass grafting improve 3-year clinical outcomes in diabetic patients with stable coronary artery disease?
Cohort (n=820)
No
Does drug-eluting stent implantation compared to coronary artery bypass grafting improve 3-year clinical outcomes in diabetic patients with stable coronary artery disease?
Answers are grounded in this paper and cite their sources.
Diabetes duration modifies the comparative effectiveness of DES versus CABG, with CABG showing a MACCE benefit only in patients with diabetes duration of 5 years or more.
OBJECTIVE: The aim of this study was to evaluate the impact of diabetes duration on long-term clinical outcomes after drug-eluting stent (DES) implantation or coronary artery bypass grafting (CABG). METHODS: A total of 820 diabetic patients treated with initial DES (n=451) or CABG (n=369) were consecutively enrolled in this single-center follow-up study. The main outcomes included major adverse cardiac events and major adverse cardiac or cerebrovascular events (MACCEs). Cox regression analysis with propensity adjustment was used for data analysis. RESULTS: Three-year risks of major adverse cardiac events were significantly higher in the DES group compared with the CABG group irrespective of whether the diabetes durations were less or more than 5 years [hazard ratio (HR) 2.27, 95% confidence interval (CI) 1.19-4.31, P=0.01; HR 3.73, 95% CI 2.72-10.12, P<0.01; P for interaction=0.28]. A similar trend was observed for repeat revascularization. However, CABG was associated with increased risk of stroke, especially in the patients with diabetes duration of at least 5 years (HR 0.02, 95% CI 0.002-0.12, P<0.01). Three-year risk of MACCEs was significantly higher in the DES group in patients with diabetes duration of at least 5 years (HR 2.13, 95% CI 1.34-3.39, P<0.01), but not for those less than 5 years (HR 1.03, 95% CI 0.65-1.63, P=0.91). A statistically significant interaction between diabetes duration and treatment strategy was found for MACCEs (P for interaction=0.04). CONCLUSION: Short diabetes duration (<5 years) was associated with equal risk of MACCEs among stable coronary artery disease patients with DES and CABG, emphasizing the need to consider the duration of diabetes when determining the best strategy for patients undergoing coronary revascularization.
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Gao et al. (2016) conducted a cohort in Stable coronary artery disease with diabetes (n=820). Drug-eluting stent (DES) vs. Coronary artery bypass grafting (CABG) was evaluated on Major adverse cardiac events (HR 2.27, 95% CI 1.19-4.31, p=0.01). DES implantation was associated with a higher 3-year risk of major adverse cardiac events compared to CABG in diabetic patients, regardless of diabetes duration <5 years (HR 2.27) or ≥5 years (HR 3.73).
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