title: Everolimus Eluting Stents Versus Coronary Artery Bypass Graft Surgery for Patients With Diabetes Mellitus and Multivessel Disease.
abstract: BACKGROUND
  In patients with diabetes mellitus and multivessel disease, coronary artery bypass graft surgery and percutaneous coronary intervention are treatment options. However, there is paucity of data comparing coronary artery bypass graft surgery against newer generation stents.
  
  
  RESULTS
  Patients included in the New York State registries who had diabetes mellitus and underwent isolated coronary artery bypass graft surgery or percutaneous coronary intervention with everolimus eluting stent (EES) for multivessel disease were included. Propensity score matching was used to assemble a cohort with similar baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. Short-term (within 30 days) and long-term outcomes were evaluated. Among 16,089 patients with diabetes mellitus and multivessel disease, 8096 patients with similar propensity scores were included. At short-term, EES was associated with a lower risk of death (hazard ratio [HR] =0.58; 95% confidence interval [CI], 0.34-0.98; P=0.04) and stroke (HR=0.14; 95% CI, 0.06-0.30; P<0.0001) but higher risk of MI (HR=2.44; 95% CI, 1.13-5.31; P=0.02). At long-term, EES was associated with a similar risk of death (425 [10.50%] versus 414 [10.23%] events; HR=1.12; 95% CI, 0.96-1.30; P=0.16), a lower risk of stroke (118 [2.92%] versus 157 [3.88%] events; HR=0.76; 95% CI, 0.58-0.99; P=0.04) but a higher risk of MI (260 [6.42%] versus 166 [4.10%] events; HR=1.64; 95% CI, 1.32-2.04; P<0.0001) and repeat revascularization (889 [21.96%] versus 421 [10.40%] events; HR=2.42; 95% CI, 2.12-2.76; P<0.0001). The higher risk of MI was not seen in the subgroup of EES patients who underwent complete revascularization (HR=1.37; 95% CI, 0.76-2.47; P=0.30).
  
  
  CONCLUSIONS
  In patients with diabetes mellitus and multivessel disease, EES was associated with lower upfront risk of death and stroke when compared with coronary artery bypass graft surgery. However, at long-term, EES was associated with similar risk of death, a higher risk of MI (in those with incomplete revascularization), and repeat revascularization but a lower risk of stroke.
authors.affiliation: From the Department of Medicine (S.B.), Department of Population Health (Y.G., S.B., J.X.), New York University School of Medicine, New York, NY; and University at Albany School of Public Health, Rensselaer, NY (Z.S., E.L.H.). sripalbangalore@gmail.com.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: From the Department of Medicine (S.B.), Department of Population Health (Y.G., S.B., J.X.), New York University School of Medicine, New York, NY; and University at Albany School of Public Health, Rensselaer, NY (Z.S., E.L.H.).
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: From the Department of Medicine (S.B.), Department of Population Health (Y.G., S.B., J.X.), New York University School of Medicine, New York, NY; and University at Albany School of Public Health, Rensselaer, NY (Z.S., E.L.H.).
authors.forename: Zaza
authors.initials: Z
authors.lastname: Samadashvili
authors.affiliation: From the Department of Medicine (S.B.), Department of Population Health (Y.G., S.B., J.X.), New York University School of Medicine, New York, NY; and University at Albany School of Public Health, Rensselaer, NY (Z.S., E.L.H.).
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.affiliation: From the Department of Medicine (S.B.), Department of Population Health (Y.G., S.B., J.X.), New York University School of Medicine, New York, NY; and University at Albany School of Public Health, Rensselaer, NY (Z.S., E.L.H.).
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Xu
authors.affiliation: From the Department of Medicine (S.B.), Department of Population Health (Y.G., S.B., J.X.), New York University School of Medicine, New York, NY; and University at Albany School of Public Health, Rensselaer, NY (Z.S., E.L.H.).
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
mesh_terms: D000368:Aged; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D009204:Myocardial Revascularization / Q000401:mortality; D012042:Registries; D020521:Stroke / Q000401:mortality
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus
keywords: coronary artery bypass graft; diabetes mellitus; multivessel disease; percutaneous coronary intervention