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.
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.
Sedlis
Steven P
SP
Section of Cardiology, 12W, New York VA Medical Center, 423 East 23rd Street, New York, NY 10010, USA. steven.sedlis@med.va.gov
Morrison
Douglass A
DA
Lorin
Jeffrey D
JD
Esposito
Rick
R
Sethi
Gulshan
G
Sacks
Jerome
J
Henderson
William
W
Grover
Frederick
F
Ramanathan
K B
KB
Weiman
Darryl
D
Saucedo
Jorge
J
Antakli
Tamim
T
Paramesh
Venki
V
Pett
Stuart
S
Vernon
Sarah
S
Birjiniuk
Vladimir
V
Welt
Frederick
F
Krucoff
Mitchell
M
Wolfe
Walter
W
Lucke
John C
JC
Mediratta
Sundeep
S
Booth
David
D
Murphy
Edward
E
Ward
Herbert
H
Miller
LaWayne
L
Kiesz
Stefan
S
Barbiere
Charles
C
Lewis
Dan
D
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