title: Percutaneous coronary intervention versus coronary bypass graft surgery for diabetic patients with unstable angina and risk factors for adverse outcomes with bypass: outcome of diabetic patients in the AWESOME randomized trial and registry.
abstract: OBJECTIVE
  This study compared survival after percutaneous coronary intervention (PCI) with survival after coronary artery bypass graft surgery (CABG) among diabetics in the Veterans Affairs AWESOME (Angina With Extremely Serious Operative Mortality Evaluation) study randomized trial and registry of high-risk patients.
  
  
  BACKGROUND
  Previous studies indicate that CABG may be superior to PCI for diabetics, but no comparisons have been made for diabetics at high risk for surgery.
  
  
  METHODS
  Over five years (1995 to 2000), 2,431 patients with medically refractory myocardial ischemia and at least one of five risk factors (prior CABG, myocardial infarction within seven days, left ventricular ejection fraction <0.35, age >70 years, or an intra-aortic balloon being required to stabilize) were identified. A total of 781 were acceptable for CABG and PCI, and 454 consented to be randomized. The 1,650 patients not acceptable for both CABG and PCI constitute the physician-directed registry, and the 327 who were acceptable but refused to be randomized constitute the patient-choice registry. Diabetes prevalence was 32% (144) among randomized patients, 27% (89) in the patient-choice registry, and 32% (525) in the physician-directed registry. The CABG and PCI survival rates were compared using Kaplan-Meier curves and log-rank tests.
  
  
  RESULTS
  The respective CABG and PCI 36-month survival rates for diabetic patients were 72% and 81% for randomized patients, 85% and 89% for patient-choice registry patients, and 73% and 71% for the physician-directed registry patients. None of the differences was statistically significant.
  
  
  CONCLUSIONS
  We conclude that PCI is a relatively safe alternative to CABG for diabetic patients with medically refractory unstable angina who are at high risk for CABG.
authors.affiliation: Section of Cardiology, 12W, New York VA Medical Center, 423 East 23rd Street, New York, NY 10010, USA. steven.sedlis@med.va.gov
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
authors.forename: Douglass A
authors.initials: DA
authors.lastname: Morrison
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Lorin
authors.forename: Rick
authors.initials: R
authors.lastname: Esposito
authors.forename: Gulshan
authors.initials: G
authors.lastname: Sethi
authors.forename: Jerome
authors.initials: J
authors.lastname: Sacks
authors.forename: William
authors.initials: W
authors.lastname: Henderson
authors.forename: Frederick
authors.initials: F
authors.lastname: Grover
authors.forename: K B
authors.initials: KB
authors.lastname: Ramanathan
authors.forename: Darryl
authors.initials: D
authors.lastname: Weiman
authors.forename: Jorge
authors.initials: J
authors.lastname: Saucedo
authors.forename: Tamim
authors.initials: T
authors.lastname: Antakli
authors.forename: Venki
authors.initials: V
authors.lastname: Paramesh
authors.forename: Stuart
authors.initials: S
authors.lastname: Pett
authors.forename: Sarah
authors.initials: S
authors.lastname: Vernon
authors.forename: Vladimir
authors.initials: V
authors.lastname: Birjiniuk
authors.forename: Frederick
authors.initials: F
authors.lastname: Welt
authors.forename: Mitchell
authors.initials: M
authors.lastname: Krucoff
authors.forename: Walter
authors.initials: W
authors.lastname: Wolfe
authors.forename: John C
authors.initials: JC
authors.lastname: Lucke
authors.forename: Sundeep
authors.initials: S
authors.lastname: Mediratta
authors.forename: David
authors.initials: D
authors.lastname: Booth
authors.forename: Edward
authors.initials: E
authors.lastname: Murphy
authors.forename: Herbert
authors.initials: H
authors.lastname: Ward
authors.forename: LaWayne
authors.initials: L
authors.lastname: Miller
authors.forename: Stefan
authors.initials: S
authors.lastname: Kiesz
authors.forename: Charles
authors.initials: C
authors.lastname: Barbiere
authors.forename: Dan
authors.initials: D
authors.lastname: Lewis
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality; D018572:Disease-Free Survival; D006801:Humans; D018579:Patient Selection; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome