title: Five-year outcomes of surgical or percutaneous myocardial revascularization in diabetic patients.
abstract: BACKGROUND
  The study compares five-year clinical outcomes of CABG vs PCI in a real world population of diabetic patients with multivessel coronary disease since it is not clear whether to prefer surgical or percutaneous revascularization.
  
  
  METHODS
  Between July 2002 and December 2008, 2885 multivessel coronary diabetic patients underwent revascularization (1466 CABG and 1419 PCI) at hospitals in Emilia-Romagna Region, Italy and were followed for 1827 ± 617 days by record linkage of two clinical registries with the regional administrative database of hospital admissions and the mortality registry. Five-year incidences of MACCE (mortality, acute myocardial infarction [AMI], stroke, and repeat revascularization [TVR]) were assessed with Kaplan-Meier estimates, Cox proportional hazards regression and cumulative incidence functions of death and TVR, to evaluate the competing risk of AMI on death and TVR. The same analyses were applied to the propensity score matched subgroup of patients undergoing CABG or PCI with DES and with complete revascularization.
  
  
  RESULTS
  PCI had higher mortality for all causes (HR: 1.8, 95% CI 1.4-2.2 p<0.0001), AMI (HR: 3.3, 95% CI 2.4-4.6 p<0.0001) and TVR (HR: 4.5, 95% CI 3.4-6.1 p<0.0001). No significant differences emerged for stroke (HR: 0.8, 95% CI 0.5-1.2 p=0.26). The higher incidence of AMI caused higher mortality in PCI group. Results did not change comparing CABG with PCI patients receiving complete revascularization or DES only.
  
  
  CONCLUSIONS
  Diabetics show a higher incidence of MACCE with PCI than with CABG: thus diabetes and its degree of control should be considered when choosing the type of revascularization.
authors.affiliation: Unità Operativa di Cardiochirurgia, Dipartimento Cardio-nefro-polmonare, Azienda Ospedaliero-Universitaria di Parma, Italy. Electronic address: acontini@ao.pr.it.
authors.forename: Giovanni Andrea
authors.initials: GA
authors.lastname: Contini
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.forename: Daniela
authors.initials: D
authors.lastname: Fortuna
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Antonio
authors.initials: A
authors.lastname: Manari
authors.forename: Claudio
authors.initials: C
authors.lastname: Zussa
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.forename: Roberto
authors.initials: R
authors.lastname: Grilli
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome