Key result
CABG plus optimal medical therapy remained superior to PCI or medical therapy alone for reducing 5-year death, MI, or stroke, irrespective of presenting angina severity.
Why the study?
Does revascularization (CABG or PCI) plus optimal medical therapy improve outcomes compared to optimal medical therapy alone in patients with stable CAD and T2DM, and is this influenced by presenting angina severity?
Meta-Analysis (n=5,027)
Yes
Does revascularization (CABG or PCI) plus optimal medical therapy improve outcomes compared to optimal medical therapy alone in patients with stable CAD and T2DM, and is this influenced by presenting angina severity?
In patients with stable CAD and T2DM, CABG plus optimal medical therapy remains superior for reducing long-term cardiovascular events regardless of baseline angina severity, though its benefit for 1-year angina control is limited to those with more severe baseline symptoms.
Angina severity does not modify CABG + OMT superiority for death/MI/stroke in stable diabetic CAD; confirms strategy preference irrespective of symptoms.
BACKGROUND AND AIMS: The impact of treatment strategies on outcomes in patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) according to presenting angina has not been rigorously assessed. METHODS: We performed a patient-level pooled-analysis (n = 5027) of patients with stable CAD and T2DM randomized to optimal medical therapy [OMT], percutaneous coronary intervention [PCI] + OMT, or coronary artery bypass grafting [CABG] + OMT. Endpoints were death/myocardial infarction (MI)/stroke, post-randomization revascularization (both over 5 years), and angina control at 1 year. RESULTS: Increasing severity of baseline angina was associated with higher rates of death/MI/stroke (p = 0.009) and increased need for post-randomization revascularization (p = 0.001); after multivariable adjustment, only association with post-randomization revascularization remained significant. Baseline angina severity did not influence the superiority of CABG + OMT to reduce the rate of death/MI/stroke and post-randomization revascularization compared to other strategies. CABG + OMT was superior for angina control at 1 year compared to both PCI + OMT and OMT alone but only in patients with ≥ Class II severity at baseline. Comparisons between PCI + OMT and OMT were neutral except that PCI + OMT was superior to OMT for reducing the rate of post-randomization revascularization irrespective of presenting angina severity. CONCLUSIONS: Presenting angina severity did not influence the superiority of CABG + OMT with respect to 5-year rates of death/MI/stroke and need for post-randomization revascularization. Presenting angina severity minimally influenced relative benefits for angina control at 1 year.
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Mancini et al. (2018) conducted a meta-analysis in Stable coronary artery disease and type 2 diabetes mellitus (n=5,027). CABG + OMT or PCI + OMT vs. Optimal medical therapy (OMT) alone was evaluated on Death/myocardial infarction/stroke, post-randomization revascularization at 5 years, and angina control at 1 year. CABG plus optimal medical therapy remained superior to PCI or medical therapy alone for reducing 5-year death, MI, or stroke, irrespective of presenting angina severity.
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