TY - JOUR
T1 - Ten-year all-cause death after percutaneous or surgical revascularization in diabetic patients with complex coronary artery disease
AU - Wang, Rutao
AU - Serruys, Patrick W.
AU - Gao, Chao
AU - Hara, Hironori
AU - Takahashi, Kuniaki
AU - Ono, Masafumi
AU - Kawashima, Hideyuki
AU - O'leary, Neil
AU - Holmes, David R.
AU - Witkowski, Adam
AU - Curzen, Nick
AU - Burzotta, Francesco
AU - James, Stefan
AU - Van Geuns, Robert Jan
AU - Kappetein, Arie Pieter
AU - Morel, Marie Angele
AU - Head, Stuart J.
AU - Thuijs, Daniel J.F.M.
AU - Davierwala, Piroze M.
AU - O'Brien, Timothy
AU - Fuster, Valentin
AU - Garg, Scot
AU - Onuma, Yoshinobu
N1 - Publisher Copyright:
© 2022 Oxford University Press. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Aims: The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes. Methods and results: The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: -7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: -6.5%, 22.5%, P = 0.227). Conclusions: The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials.
AB - Aims: The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes. Methods and results: The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: -7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: -6.5%, 22.5%, P = 0.227). Conclusions: The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials.
KW - All-cause death
KW - Coronary artery bypass grafting
KW - Diabetes
KW - Percutaneous coronary intervention
KW - SYNTAX
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U2 - 10.1093/eurheartj/ehab441
DO - 10.1093/eurheartj/ehab441
M3 - Article
C2 - 34405232
AN - SCOPUS:85113416155
SN - 0195-668X
VL - 43
SP - 56
EP - 67
JO - European heart journal
JF - European heart journal
IS - 1
ER -