Diabetes does not influence treatment decisions regarding revascularization in patients with stable coronary artery disease.
OBJECTIVE
To evaluate whether in stable angina preference for coronary revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) is influenced by diabetes status and whether this has prognostic implications.


METHODS
A total of 2,928 consecutive patients with stable angina who were enrolled in the prospective Euro Heart Survey on Coronary Revascularization were studied. Multivariable analyses were applied to evaluate the relation between diabetes, treatment decision, and 1-year outcome.


RESULTS
Diabetes was documented in 587 patients (20%) who had more extensive coronary disease. Revascularization was intended in 74% of patients with diabetes and in 77% of those without diabetes. In patients selected for revascularization, CABG was intended in 35% of diabetic and in 33% of nondiabetic patients. Multivariable analyses did not change these findings, but in some subgroups diabetes influenced treatment decisions. For example, diabetic subjects with mild heart failure had more often intended revascularization (91%) than those without diabetes (67%, P < 0.001). Treatment decisions in patients with more extensive (left main, multivessel, or proximal left anterior descending artery) disease were not influenced by diabetes status. Diabetes was not associated with an increased incidence of all-cause death, nonfatal cerebrovascular accident, or nonfatal myocardial infarction at 1 year, regardless of preferred treatment. The incidence of the combined end points was 7.3% in diabetic and 6.8% in nondiabetic patients (adjusted hazard ratio 1.0 [95% CI 0.7-1.4]).


CONCLUSIONS
In stable angina, treatment decisions regarding revascularization or the choice for CABG or PCI were not influenced by the presence of diabetes. Diabetes was not associated with a poor prognosis.
Breeman
Arno
A
Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
Bertrand
Michel E
ME
Ottervanger
Jan Paul
JP
Hoeks
Sanne
S
Lenzen
Mattie
M
Sechtem
Udo
U
Legrand
Victor
V
de Boer
Menko-Jan
MJ
Wijns
William
W
Boersma
Eric
E
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications; D003920:Diabetes Mellitus / Q000473:pathology*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome