Long-term clinical outcome of patients with diabetes proposed for coronary revascularisation.
BACKGROUND
The optimal method of revascularisation in diabetic patients with coronary artery disease (CAD) remains controversial. It was our aim to evaluate long-term outcome in diabetic patients with CAD in daily practice, in whom an invasive approach was considered.


METHODS
A prospective follow-up study of patients with CAD in whom a coronary revascularisation procedure was considered. Follow-up data were obtained on the vital status up to ten years after inclusion.


RESULTS
Of the 872 included patients, a total of 107 patients (12%) had diabetes. Patients with diabetes were older and more frequently female. Long-term mortality was higher in diabetics than nondiabetics (36 vs 25%, p = 0.01). This association was observed in both medically treated patients (65 vs 31%, p = 0.01) and in those treated by percutaneous coronary intervention (41 vs 24%, p = 0.02). There was, however, no difference in mortality in diabetes vs nondiabetes patients after coronary artery bypass grafting (24 vs 24%, p = 0.89). Multivariate analysis did not change these findings.


CONCLUSIONS
Diabetic patients with significant CAD had a higher long-term mortality compared with patients without diabetes. In patients with diabetes, survival was highest after coronary artery bypass grafting and appeared to be comparable between diabetic and nondiabetic patients. Complete revascularisation may decrease the influence of diabetes on survival.
Timmer
J R
JR
Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
Breeman
A
A
Ottervanger
J P
JP
de Kluiver
E P
EP
Boonstra
P W
PW
Zijlstra
F
F
D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003920:Diabetes Mellitus / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome