Comparison of bilateral thoracic artery grafting with percutaneous coronary interventions in diabetic patients.
BACKGROUND
This study compares the outcome of percutaneous coronary interventions (PCI) with bilateral internal thoracic grafting (BITA) in diabetic patients.


METHODS
From May 1996 to December 1999, 802 consecutive diabetic patients underwent myocardial revascularization: 363 by PCI and 439 by BITA. The two groups were similar; however, left main disease (28% versus 3.3%), ejection fraction less than 0.35 (14.5% versus 5.5%), and chronic obstructive lung disease (8.4% versus 3%) were more prevalent in the BITA group, and prior percutaneous transluminal coronary angioplasty, in the PCI group (16.8% versus 10.5%).


RESULTS
The number of coronary vessels treated per patient was higher in the BITA group (3.4 versus 1.2; p < 0.001). Thirty-day mortality was similar: 3.4% in the BITA group and 2.8% in the PCI group. Late follow-up (3 to 6.5 years) showed decreased return of angina (11% versus 64%; p < 0.001), fewer reinterventions (2.7% versus 55%; p < 0.001), and increased cardiovascular event-free survival (80% versus 30%; p < 0.001) in the BITA group. Six-year survival of BITA and PCI patients was 85.5% and 81.2%, respectively (not significant). However, survival of the subgroups of patients with left main or three-vessel coronary artery disease was significantly better with BITA (86% versus 76%; p = 0.003).


CONCLUSIONS
Despite higher risk profile of diabetic patients treated surgically by BITA, their late outcome is better than that of patients treated by PCI. The results of this study support referring diabetics with single-vessel or double-vessel disease to PCI and those with three-vessel and left main coronary artery disease to surgery.
Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6Tel Aviv 64239, Israel.
Chaim
C
Locker
Rephael
R
Mohr
Oren
O
Lev-Ran
Gideon
G
Uretzky
Aharon
A
Frimerman
Yael
Y
Shaham
Itzhak
I
Shapira
D000077284:Abciximab; D000368:Aged; D000800:Angioplasty, Balloon; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D048909:Diabetes Complications / Q000188:drug therapy / Q000601:surgery*; D004110:Diltiazem / Q000627:therapeutic use; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007548:Isosorbide Dinitrate / Q000627:therapeutic use; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013895:Thoracic Arteries / Q000601:surgery*; D013988:Ticlopidine / Q000627:therapeutic use; D016896:Treatment Outcome; D014654:Vascular Patency
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D004110:Diltiazem; D007548:Isosorbide Dinitrate; D000077542:Eptifibatide; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab