CABG May Have Better Outcomes Than PCI in Diabetes With LV Dysfunction

surgeons performing heart surgery
surgeons performing heart surgery
In patients with diabetes, multivessel coronary artery disease, and left ventricular dysfunction, coronary artery bypass grafting was associated with a reduction in major adverse cardiac and cerebrovascular events and mortality.

HealthDay News — Coronary artery bypass grafting (CABG) is associated with a significant reduction in major adverse cardiac and cerebrovascular events and mortality compared with percutaneous coronary intervention (PCI) among patients with diabetes mellitus (DM), multivessel coronary artery disease (CAD), and left ventricular dysfunction (LVD), according to a study published in the Journal of the American College of Cardiology.

Jeevan Nagendran, MD, PhD, from the University of Alberta in Canada, and colleagues evaluated whether treatment with PCI or CABG leads to improved outcomes in patients with DM, CAD, and LVD. Patients in the study underwent isolated CABG without a concomitant procedure or PCI between January 1, 2004, and March 31, 2016. The researchers included 2837 patients in the study analysis and 1738 in propensity-score matched analysis.

The researchers found that compared to CABG, PCI was associated with a higher risk for major adverse cardiac and cerebrovascular events at 5 years in patients with ejection fraction (EF) 35% to 49% and <35% (51% vs 28% and 61% vs 29%, respectively). PCI was also associated with an increased risk for death in both of the EF cohorts at 5 years (26% vs 16% and 35% vs 19%, respectively). The stroke rate was similar for PCI and CABG in both EF cohorts. In the EF <35% cohort, PCI was associated with an increased rate of myocardial infarction. In patients treated with PCI compared with CABG in both the EF cohorts, repeat revascularization occurred more frequently.

“At long-term follow-up, patients with CAD, DM, and LVD treated with CABG exhibited a significantly lower incidence of major adverse cardiac and cerebrovascular events and better long-term survival over PCI, without a higher risk of stroke,” the authors wrote.

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Nagendran J, Bozso SJ, Norris CM, et al. Coronary artery bypass grafting surgery improves outcomes in patients with diabetes and left ventricular dysfunction. J Am Coll Cardiol. 2018;71(8):819-827.