title: PCI versus CABG for multivessel coronary disease in diabetics.
abstract: OBJECTIVE
  To explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in diabetic patients with multivessel disease (MVD) compared with coronary artery bypass graft (CABG), when it is based on clinical judgment.
  
  
  BACKGROUND
  Diabetes mellitus (DM) is a major risk factor for poor outcome after PCI. However, PCI may result in better outcome if the choice of revascularization (PCI versus CABG) is based on the physician decision, rather than randomization. Limited experiences have compared revascularization by DES-PCI versus CABG in DM patients with MVD.
  
  
  METHODS
  From August 2004 to August 2005, 220 consecutive DM patients with MVD underwent DES-PCI (93) or CABG (127) at our Institution. The type of revascularization was dependent on patient and/or physician choice. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, repeat coronary revascularization, and stroke.
  
  
  RESULTS
  Compared with PCI patients, CABG patients had higher prevalence of 3-vessel disease (P < 0.001), significant LAD involvement (P < 0.001), presence of total occlusions (P = 0.04), collateral circulation (P < 0.001). At 2-year follow-up, MACCE were not different between CABG group and DES-PCI group (OR 1.2; P = 0.6) and, only when the clinical judgment on the revascularization choice was excluded at propensity analysis, DES-PCI increased the risk of 24-month MACCE in total population (OR 1.8; P = 0.04).
  
  
  CONCLUSIONS
  For patients with DM and MVD, a clinical judgment-based revascularization by DES-PCI is not associated with worse 2-year outcome compared with CABG.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy. giuseppe.tarantini.1@unipd.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Angelo
authors.initials: A
authors.lastname: Ramondo
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Enrico
authors.initials: E
authors.lastname: Favaretto
authors.forename: Arianna
authors.initials: A
authors.lastname: Gardin
authors.forename: Claudio
authors.initials: C
authors.lastname: Bilato
authors.forename: Georghios
authors.initials: G
authors.lastname: Nesseris
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery / Q000628:therapy*; D019992:Databases as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery / Q000628:therapy*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome