title: Drug-eluting stents compared with bilateral internal thoracic artery grafts for diabetic patients.
abstract: BACKGROUND
  Diabetic patients with multivessel coronary artery disease who undergo coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI) are at greater risk of late morbidity and mortality than nondiabetic patients. We questioned earlier comparisons of these two approaches that showed no differences in survival rates. This study compares drug-eluting stents (DES) and bilateral internal thoracic artery (BITA) grafting in diabetic patients with multivessel coronary artery disease.
  
  
  METHODS
  All diabetic patients who underwent left-sided arterial revascularization with BITA grafting between January 2002 and May 2006 were evaluated. Their outcomes were compared with those of diabetic patients who underwent PCI with DES (Cypher). The Cox proportional hazards model defined predictors of outcome events after forcing propensity score with patients' characteristics into the model.
  
  
  RESULTS
  The outcomes of 226 BITA patients were compared with those of 271 DES patients (mean follow-up 62 months). The 5-year reintervention-free survival (Kaplan-Meier 86% versus 65%, log rank p = 0.000) and major adverse cardiovascular events-free survival (81% versus 54%, p = 0.001) were significantly better in the BITA group. Assignment to the PCI group was associated with decreased adjusted survival (hazard ratio 3.01, 95% confidence interval: 1.59 to 5.73, p = 0.000) and increased risk of target vessel reinterventions (hazard ratio 7.00, 95% confidence interval: 3.1 to 15.70). The adjusted risk of major adverse cardiovascular events increased with the number of DES-treated vessels.
  
  
  CONCLUSIONS
  This is the first demonstration of significantly better long-term adjusted survival and outcomes of diabetic patients who underwent CABG with BITA grafting compared with diabetic patients who underwent PCI with DES.
authors: Assuta Medical Center, Tel Aviv, Israel.
authors: Yaron
authors: Y
authors: Moshkovitz
authors: Rephael
authors: R
authors: Mohr
authors: Benjamin
authors: B
authors: Medalion
authors: Eytan
authors: E
authors: Hyam
authors: Itzhak
authors: I
authors: Herz
authors: Iris
authors: I
authors: Deitch
authors: Gideon
authors: G
authors: Uretzky
authors: Dimitri
authors: D
authors: Pevni
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D012189:Retrospective Studies