Comparison of bypass surgery with drug-eluting stents for diabetic patients with multivessel disease.
BACKGROUND
This retrospective study of prospectively collected data compared coronary artery bypass graft (CABG) surgery to drug-eluting stenting (DES) in diabetic patients with multivessel coronary artery disease (CAD). Prior randomized trials and clinical studies have suggested that CABG may be the preferred revascularization strategy in diabetic patients with multivessel CAD. Data are limited regarding the impact of DES vs. CABG on clinical outcomes.


METHODS
We included 205 consecutive diabetic patients who underwent either CABG (n=103) or DES (n=102). The primary clinical end points were freedom from major adverse cardiac events (MACE) at 30 days and 1 year.


RESULTS
Baseline characteristics were similar between both groups. At 1 year, the mortality rate was similar in the CABG and DES group (8% vs. 10%, p=0.6) but the MACE rate was lower in the CABG group (12% vs. 27%, p=0.006) due to less repeat revascularization with CABG (3% vs. 20%, p<0.001). Stroke occurred only in the CABG group (4% vs. 0%, p=0.04). Angiographically-documented stent thrombosis after DES occurred in 3%. Presentation with acute myocardial infarction (hazard ratio [HR], 2.26, 95% CI, 1.13 to 4.55) and DES (HR, 2.4, 95% CI, 1.23 to 4.77) were positive independent predictors, whereas therapy with a statin was a negative independent predictor of MACE (HR, 0.40, 95% CI, 0.21 to 0.76).


CONCLUSIONS
Bypass surgery was associated with less MACE primarily due to the higher repeat revascularization rate with DES and is therefore superior to DES despite more extensive CAD in CABG patients.
Lee
Michael S
MS
University of California, Los Angeles School of Medicine, Los Angeles, California, USA. michaelslee@pol.net
Jamal
Faizi
F
Kedia
Gautam
G
Chang
Gilbert
G
Kapoor
Nikhil
N
Forrester
James
J
Czer
Lawrence
L
Zimmer
Raymond
R
DeRobertis
Michele
M
Trento
Alfredo
A
Makkar
Raj R
RR
D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000494:pharmacology; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D017239:Paclitaxel / Q000494:pharmacology; D012189:Retrospective Studies; D020123:Sirolimus / Q000494:pharmacology; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D000972:Antineoplastic Agents, Phytogenic; D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus