Diabetes Mellitus and Coronary Revascularization: Comparing Outcomes Between Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention

TL;DR

This study compares long-term outcomes of two heart treatments for diabetic patients with severe artery disease, finding CABG may offer slight benefits over PCI.

Contribution

A multicenter comparison of CABG and PCI in diabetic patients with multi-vessel CAD, focusing on long-term survival and cardiac events.

Findings

CABG showed higher survival rates (88%) compared to PCI (82%), though not statistically significant.

MACE incidence was lower in the CABG group (22%) than in the PCI group (28%).

CABG treated more vessels on average than PCI, indicating its potential for complex cases.

Abstract

Background

Coronary artery disease (CAD) significantly contributes to morbidity and mortality globally, particularly in individuals with diabetes mellitus, who are at a heightened risk for cardiovascular complications. The complexity of coronary lesions and diffuse atherosclerosis in diabetic patients presents challenges in their treatment and prognosis. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are primary revascularization strategies for managing multi-vessel CAD in diabetic patients. Despite advancements in both techniques, their relative efficacy and safety remain debated, especially in the diabetic population.

Objective

This multicenter study aims to compare the long-term outcomes of CABG and PCI in diabetic patients with multi-vessel CAD. The primary endpoints include overall survival and the incidence of major adverse cardiac events (MACE). Secondary endpoints encompass revascularization success and procedural complication rates.

Methods

This retrospective cohort study was conducted across multiple centers, and the research spanned from January 2020 to December 2021. A total of 500 diabetic patients with multi-vessel CAD were included: 250 underwent CABG and 250 received PCI. Data were collected from electronic health records, capturing demographic details, clinical characteristics, procedural specifics, and follow-up outcomes over 24 months. Statistical analyses were performed using SPSS version 25 (IBM Corp., Armonk, NY), including Kaplan-Meier survival curves and Cox proportional hazards regression.

Results

The mean age of participants was 60.3 ± 10.5 years, with males constituting 52% of each group. Both groups achieved a high revascularization success rate of 90%. The CABG group treated more vessels on average (2.3 ± 0.7) compared to the PCI group (1.9 ± 0.8) (p < 0.001). Survival rates were higher in the CABG group (88%) compared to the PCI group (82%) (p = 0.08). MACE incidence was lower in the CABG group (22%) compared to the PCI group (28%) (p = 0.10). Procedural complications were marginally higher in the CABG group (16%) than in the PCI group (14%) (p = 0.60).

Conclusion

Both CABG and PCI are effective revascularization options for diabetic patients with multi-vessel CAD. CABG may offer a slight advantage in long-term survival and reduction in MACE, although the differences were not statistically significant. These findings suggest that individualized treatment strategies should be considered to optimize patient outcomes.

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