Comparing outcomes after off-pump coronary artery bypass versus drug-eluting stent in diabetic patients.
BACKGROUND
Off-pump coronary artery bypass surgery and sirolimus-eluting stent placement have been widely used for the treatment of coronary artery disease. The goal of this study was to compare long-term outcomes after off-pump coronary artery bypass surgery or sirolimus-eluting stent placement in diabetic patients with multivessel disease.


METHODS
This observational study enrolled 350 off-pump coronary artery bypass patients and 143 sirolimus-eluting stent patients receiving care at our institution between 2000 and 2007. All patients had diabetes and multivessel disease including proximal left anterior descending or left main coronary artery. The choice of revascularization (percutaneous coronary intervention versus coronary artery bypass surgery) was left to the physician's discretion rather than randomization. Cox proportional-hazard analyses, adjusting baseline risk factors and propensity score, which predicted the probability of receiving off-pump coronary artery bypass, were conducted to evaluate outcomes, including all-cause mortality, cardiac death, target vessel revascularization, and major adverse cardiac and cerebrovascular events.


RESULTS
During the follow-up (2.6±1.6 years) period, there was no difference between off-pump coronary artery bypass and sirolimus-eluting stent placement in all-cause mortality or cardiac death. However, the incidences of acute coronary syndrome, target vessel revascularization, and major adverse cardiac and cerebrovascular events were markedly lower in the patients undergoing off-pump coronary artery bypass than in those receiving sirolimus-eluting stent placement.


CONCLUSIONS
Off-pump coronary artery bypass is superior to sirolimus-eluting stent placement in terms of acute coronary syndrome, target vessel revascularization, and major adverse cardiac and cerebrovascular events in diabetic patients with multivessel coronary artery disease.
Department of Cardiovascular Surgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
Shizuyuki
S
Dohi
Kan
K
Kajimoto
Katsumi
K
Miyauchi
Taira
T
Yamamoto
Keiichi
K
Tambara
Hirotaka
H
Inaba
Kenji
K
Kuwaki
Hiroshi
H
Tamura
Takahiko
T
Kojima
Ken
K
Yokoyama
Takeshi
T
Kurata
Hiroyuki
H
Daida
Atsushi
A
Amano
D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000628:therapy*; D048909:Diabetes Complications / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D020123:Sirolimus / Q000008:administration & dosage; D016896:Treatment Outcome
D020123:Sirolimus