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 - Funding Information:
The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial was funded during 0-5 year follow-up by Boston Scientific Corporation (Marlborough, MA, USA). Both sponsors had no role in the study design, data collection, data analyses, and interpretation of the study data nor were involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom. This work, R.W., and C.G. are supported by Science Foundation Research Professorship Award (15/RP/2765).
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 -