title: Impact of diabetes on 10-year outcomes of patients with multivessel coronary artery disease in the Medicine, Angioplasty, or Surgery Study II (MASS II) trial.
abstract: BACKGROUND
  Diabetes mellitus is a major cause of coronary artery disease (CAD). Despite improvement in the management of patients with stable CAD, diabetes remains a major cause of increased morbidity and mortality. There is no conclusive evidence that either modality is better than medical therapy alone for the treatment of stable multivessel CAD in patients with diabetes in a very long-term follow-up. Our aim was to compare 3 therapeutic strategies for stable multivessel CAD in a diabetic population and non-diabetic population.
  
  
  METHODS
  It was compared medical therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) in 232 diabetic patients and 379 nondiabetic patients with multivessel CAD. Endpoints evaluated were overall and cardiac mortality.
  
  
  RESULTS
  Patients (n = 611) were randomized to CABG (n = 203), PCI (n = 205), or MT (n = 203). In a 10-year follow-up, more deaths occurred among patients with diabetes than among patients without diabetes (P = .001) for overall mortality. In this follow-up, 10-year mortality rates were 32.3% and 23.2% for diabetics and non-diabetics respectively (P = .024). Regarding cardiac mortality, 10-year cardiac mortality rates were 19.4% and 12.7% respectively (P = .031).Considering only diabetic patients and stratifying this population by treatment option, we found mortality rates of 31.3% for PCI, 27.5% for CABG and 37.5% for MT (P = .015 for CABG vs MT) and cardiac mortality rates of 18.8%, 12.5% and 26.1% respectively (P = .005 for CABG vs MT).
  
  
  CONCLUSIONS
  Among patients with stable multivessel CAD and preserved left ventricular ejection fraction, the 3 therapeutic regimens had high rates of overall and cardiac-related deaths among diabetic compared with non-diabetic patients. Moreover, better outcomes were observed in diabetic patients undergoing CABG compared to MT in relation to overall and cardiac mortality in a 10-year follow-up.
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Eduardo Gomes
authors.initials: EG
authors.lastname: Lima
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.forename: Rosa Maria Rahmi
authors.initials: RM
authors.lastname: Garcia
authors.forename: Alexandre Costa
authors.initials: AC
authors.lastname: Pereira
authors.forename: Paulo Rogério
authors.initials: PR
authors.lastname: Soares
authors.forename: Desiderio
authors.initials: D
authors.lastname: Favarato
authors.forename: Cibele Larrosa
authors.initials: CL
authors.lastname: Garzillo
authors.forename: Ricardo
authors.initials: R
authors.lastname: D'Oliveira Vieira
authors.forename: Paulo Cury
authors.initials: PC
authors.lastname: Rezende
authors.forename: Myrthes
authors.initials: M
authors.lastname: Takiuti
authors.forename: Priscyla
authors.initials: P
authors.lastname: Girardi
authors.forename: Alexandre Ciappina
authors.initials: AC
authors.lastname: Hueb
authors.forename: José A F
authors.initials: JA
authors.lastname: Ramires
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D048909:Diabetes Complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis