Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease

J Am Coll Cardiol. 1998 Jan;31(1):10-9. doi: 10.1016/s0735-1097(97)00441-5.

Abstract

Objectives: This study sought to compare the outcome of percutaneous transluminal coronary angioplasty (PTCA) (n = 834) and coronary artery bypass graft surgery (CABG) (n = 1805) in diabetic patients with multivessel coronary disease from an observational database.

Background: There is concern about selection of revascularization in diabetic patients with multivessel coronary artery disease.

Methods: Data were collected prospectively and entered into a computerized database. Follow-up was by letter or telephone or additional events resulting in readmission.

Results: After CABG there were more in-hospital deaths (0.36% vs. 4.99%, p < 0.0001) and a trend toward more Q wave myocardial infarctions than after PTCA. Five- and 10-year survival rates were 78% and 45% after PTCA and 76% and 48% after CABG, respectively (p = 0.47). At 5 and 10 years, insulin-requiring patients had lower survival rates of 72% and 31% after PTCA and 70% and 48% after CABG, respectively (p = 0.54). Multivariate correlates of long-term mortality were older age, low left ventricular ejection fraction, heart failure and hypertension. In the total group, insulin requirement was a correlate of long-term mortality. For the total group, choice of therapy had a multivariate hazard ratio close to 1. In the insulin-requiring subgroup, the multivariate hazard ratio was 1.35 (95% confidence interval 1.01 to 1.79) for PTCA versus CABG. Corrected for baseline differences, 5- and 10-year survival rates were 68% and 36% after PTCA and 75% and 47% after CABG, respectively, in the insulin-requiring subgroup. Nonfatal events were more common after PTCA, especially additional revascularization.

Conclusions: This study reveals a high incidence of events in diabetic patients and raises further questions about angioplasty in insulin-requiring diabetic patients with multivessel disease.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary*
  • Coronary Artery Bypass*
  • Coronary Disease / complications*
  • Coronary Disease / mortality
  • Coronary Disease / surgery*
  • Diabetes Complications*
  • Diabetes Mellitus / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Survival Analysis
  • Treatment Outcome