Comparison of medium-term outcomes obtained with drug-eluting stents and coronary artery bypass grafts in an unselected population of diabetic patients with multivessel coronary disease. Propensity score analysis.
OBJECTIVE
Since the introduction of drug-eluting stents, the optimum revascularization strategy in diabetic patients with multivessel coronary disease has remained controversial.


METHODS
This study used multivariate logistic regression analysis and propensity score matching to compare results in 270 consecutive diabetic patients (2000-2004) with multivessel disease (> or =2 vessels with a >70% de novo stenosis involving the proximal left anterior descending coronary artery) who underwent either coronary artery bypass grafting (CABG; n=142) or implantation of a drug-eluting stent (DES; i.e. rapamycin or paclitaxel; n=128). The following clinical outcomes (i.e. major adverse cardiac or cerebrovascular events [MACCEs]) were assessed: death, nonfatal myocardial infarction (MI), stroke and repeat revascularization at 2 years.


RESULTS
Patients who received DESs were older (67.5+/-7 years vs. 65.3+/-8 years; P=.05) and more often had a previous MI (49.2% vs. 28.2%; P< .01), but no more often had a depressed left ventricular ejection fraction < or =45% (32.4% vs. 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9+/-7 vs. 18.5+/-6; P< .001) and the quality of revascularization was better (i.e. anatomically complete revascularization: 52.8% vs. 28.1%; P< .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] = 0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR = 1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs. 12.1%; adjusted OR = 0.42; 95% CI, 0.16-1.14; P=.09).


CONCLUSIONS
In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke.
Domínguez-Franco
Antonio J
AJ
Area del Corazón, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain. antoniodominguez@secardiologia.es
Jiménez-Navarro
Manuel F
MF
Hernández-García
José M
JM
Alonso-Briales
Juan H
JH
Linde-Estrella
Antonio L
AL
Pérez-González
Olga
O
Leruite-Martín
Inés
I
Olalla-Mercadé
Eduardo
E
de Teresa-Galván
Eduardo
E
D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000150:complications*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000972:Antineoplastic Agents, Phytogenic; D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus