title: Coronary revascularization (surgical or percutaneous) decreases mortality after the first year in diabetic subjects but not in nondiabetic subjects with multivessel disease: an analysis from the Medicine, Angioplasty, or Surgery Study (MASS II).
abstract: BACKGROUND
  It is currently unknown whether revascularization procedures are associated with an improvement in mortality among diabetic subjects, as compared with a more conservative medical treatment.
  
  
  RESULTS
  In MASS II, a total of 611 patients with stable multivessel coronary disease were randomly assigned to medical treatment, surgery, or angioplasty. From these, 190 patients had diabetes (medical, 75 patients; angioplasty, 56 patients; surgery, 59 patients) and comprised the present study population. Mortality rates were analyzed for the entire 5 years of follow-up. Separate analyzes were also performed for mortality at 2 time intervals: during the first year and after the first year of follow-up. We calculated the probability of death conditional on surviving to the start of the interval analyzed. The cumulative 5-year mortality as well as the mortality during the first year of follow-up was not significantly different among treatment groups, both for diabetic and for nondiabetic subjects. Also, during years 2 to 5, the mortality of the 3 treatment groups was not different for nondiabetic subjects. Among diabetic subjects, however, patients randomized to angioplasty or surgery had a significantly lower mortality between years 2 and 5 than those allocated to medical treatment (P=0.039).
  
  
  CONCLUSIONS
  Surgery, angioplasty, and medical treatment appear to be associated with similar mortality rates for non-diabetic subjects. For diabetic subjects, however, coronary revascularization (percutaneous or surgical) significantly decreased the risk of death after the first year and up to 5 years, compared with medical treatment alone.
authors.affiliation: Heart Institute, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 sala 114, Sao Paulo-SP 05403-000, Brazil.
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Soares
authors.forename: Whady A
authors.initials: WA
authors.lastname: Hueb
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Neuza
authors.initials: N
authors.lastname: Lopes
authors.forename: Eulógio E
authors.initials: EE
authors.lastname: Martinez
authors.forename: Luis A M
authors.initials: LA
authors.lastname: Cesar
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Oliveira
authors.forename: Jose A F
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D017222:Angioplasty, Balloon, Laser-Assisted / Q000706:statistics & numerical data; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D048909:Diabetes Complications / Q000401:mortality / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000150:complications / Q000178:diet therapy / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D001241:Aspirin