Outcomes of repeat revascularization in diabetic patients with prior coronary surgery.
OBJECTIVE
This study evaluated both short- and long-term outcomes of diabetic patients who underwent repeat coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) after initial CABG.


BACKGROUND
Although diabetic patients who have multivessel coronary disease and require initial revascularization may benefit from CABG as compared with PCI, the uncertainty concerning the choice of revascularization may be greater for diabetic patients who have had previous CABG.


METHODS
Data were obtained over 15 years for diabetic patients undergoing PCI procedures or repeat CABG after previous coronary surgery. Baseline characteristics were compared between groups, and in-hospital, 5-year, and 10-year mortality rates were calculated. Multivariate correlates of in-hospital and long-term mortality were determined.


RESULTS
Both PCI (n = 1,123) and CABG (n = 598) patients were similar in age, gender, years of diabetes, and insulin dependence, but they varied in presence of hypertension, prior myocardial infarction, angina severity, heart failure, ejection fraction, and left main disease. In-hospital mortality was greater for CABG, but differences in long-term mortality were not significant (10 year mortality, 68% PCI vs. 74% CABG, p = 0.14). Multivariate correlates of long-term mortality were older age, hypertension, low ejection fraction, and an interaction between heart failure and choice of PCI. The PCI itself did not correlate with mortality.


CONCLUSIONS
The increased initial risk of redo CABG in diabetic patients and the comparable high long-term mortality regardless of type of intervention suggest that, except for patients with severe heart failure, PCI be strongly considered in all patients for whom there is a percutaneous alternative.
Cole
Jason H
JH
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Jones
Ellis L
EL
Craver
Joseph M
JM
Guyton
Robert A
RA
Morris
Douglas C
DC
Douglas
John S
JS
Ghazzal
Ziyad
Z
Weintraub
William S
WS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012086:Reoperation; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D013903:Thoracic Surgery; D013995:Time; D016896:Treatment Outcome