title: Surgical versus percutaneous coronary revascularization for multivessel disease in diabetic patients with non-ST-segment-elevation acute coronary syndrome: analysis from the Acute Catheterization and Early Intervention Triage Strategy trial.
abstract: BACKGROUND
  The preferred revascularization strategy for diabetic patients with acute coronary syndromes and multivessel coronary artery disease is uncertain. We evaluated the outcomes of diabetic patients with moderate and high-risk acute coronary syndrome and multivessel disease managed with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG).
  
  
  RESULTS
  Among 13 819 moderate and high-risk acute coronary syndrome patients enrolled in the Acute Catheterization and Early Intervention Triage Strategy (ACUITY) trial, 1772 diabetic patients had multivessel disease with left anterior descending artery involvement and were managed by PCI (n=1349) or CABG (n=423). Propensity scoring was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 326 matched patients (163 managed by PCI and 163 managed by CABG). At 30 days, treatment with PCI compared with CABG was associated with lower rates of major bleeding (15.3% versus 55.6%; P<0.0001), blood transfusions (9.2% versus 43.2%; P<0.0001), and acute kidney injury (13.4% versus 33.6%; P<0.0001), but more unplanned revascularization procedures (6.9% versus 1.9%; P=0.03). At 1 year PCI was associated with higher rates of repeat revascularization procedures (19.5% versus 5.2%; P=0.0001), with nonsignificantly different rates of myocardial infarction, stroke, and death at either 30 days or 1 year.
  
  
  CONCLUSIONS
  In the large-scale ACUITY trial, diabetic patients with acute coronary syndrome and multivessel disease treated with PCI rather than CABG had less bleeding and acute kidney injury, greater need for repeat revascularization procedures, and comparable rates of myocardial infarction, stroke, and death through 1-year follow-up.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00093158.
authors.affiliation: From the Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (Y.B.-G., R. Mohr); Department of Cardiology, New York University School of Medicine (F.F.); Department of Cardiology, Duke University Medical Center, Durham, NC (E.M.O.); Department of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital (A.K., K.X., G.W.S.); Department of Cardiology, Mount Sinai Medical Center, New York, NY (R. Mehran); and Cardiovascular Research Foundation, New York, NY (A.K., K.X., R. Mehran, G.W.S.). mdbengal@gmail.com.
authors.forename: Yanai
authors.initials: Y
authors.lastname: Ben-Gal
authors.affiliation: From the Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (Y.B.-G., R. Mohr); Department of Cardiology, New York University School of Medicine (F.F.); Department of Cardiology, Duke University Medical Center, Durham, NC (E.M.O.); Department of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital (A.K., K.X., G.W.S.); Department of Cardiology, Mount Sinai Medical Center, New York, NY (R. Mehran); and Cardiovascular Research Foundation, New York, NY (A.K., K.X., R. Mehran, G.W.S.).
authors.forename: Rephael
authors.initials: R
authors.lastname: Mohr
authors.affiliation: From the Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (Y.B.-G., R. Mohr); Department of Cardiology, New York University School of Medicine (F.F.); Department of Cardiology, Duke University Medical Center, Durham, NC (E.M.O.); Department of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital (A.K., K.X., G.W.S.); Department of Cardiology, Mount Sinai Medical Center, New York, NY (R. Mehran); and Cardiovascular Research Foundation, New York, NY (A.K., K.X., R. Mehran, G.W.S.).
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
authors.affiliation: From the Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (Y.B.-G., R. Mohr); Department of Cardiology, New York University School of Medicine (F.F.); Department of Cardiology, Duke University Medical Center, Durham, NC (E.M.O.); Department of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital (A.K., K.X., G.W.S.); Department of Cardiology, Mount Sinai Medical Center, New York, NY (R. Mehran); and Cardiovascular Research Foundation, New York, NY (A.K., K.X., R. Mehran, G.W.S.).
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.affiliation: From the Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (Y.B.-G., R. Mohr); Department of Cardiology, New York University School of Medicine (F.F.); Department of Cardiology, Duke University Medical Center, Durham, NC (E.M.O.); Department of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital (A.K., K.X., G.W.S.); Department of Cardiology, Mount Sinai Medical Center, New York, NY (R. Mehran); and Cardiovascular Research Foundation, New York, NY (A.K., K.X., R. Mehran, G.W.S.).
authors.forename: Ajay
authors.initials: A
authors.lastname: Kirtane
authors.affiliation: From the Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (Y.B.-G., R. Mohr); Department of Cardiology, New York University School of Medicine (F.F.); Department of Cardiology, Duke University Medical Center, Durham, NC (E.M.O.); Department of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital (A.K., K.X., G.W.S.); Department of Cardiology, Mount Sinai Medical Center, New York, NY (R. Mehran); and Cardiovascular Research Foundation, New York, NY (A.K., K.X., R. Mehran, G.W.S.).
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: From the Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (Y.B.-G., R. Mohr); Department of Cardiology, New York University School of Medicine (F.F.); Department of Cardiology, Duke University Medical Center, Durham, NC (E.M.O.); Department of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital (A.K., K.X., G.W.S.); Department of Cardiology, Mount Sinai Medical Center, New York, NY (R. Mehran); and Cardiovascular Research Foundation, New York, NY (A.K., K.X., R. Mehran, G.W.S.).
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: From the Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (Y.B.-G., R. Mohr); Department of Cardiology, New York University School of Medicine (F.F.); Department of Cardiology, Duke University Medical Center, Durham, NC (E.M.O.); Department of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital (A.K., K.X., G.W.S.); Department of Cardiology, Mount Sinai Medical Center, New York, NY (R. Mehran); and Cardiovascular Research Foundation, New York, NY (A.K., K.X., R. Mehran, G.W.S.).
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054058:Acute Coronary Syndrome / Q000601:surgery; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003925:Diabetic Angiopathies / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D057216:Propensity Score; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: acute coronary syndrome; coronary artery bypass; diabetes mellitus; percutaneous coronary intervention