CABG bests PCI in CAD patients with diabetes, study finds

In patients with diabetes, an early onset of atherosclerosis is commonly noted. It leads to an increased risk of progression to coronary arterial disease, researchers said.

This original study has recently been published in the journal of Seminars in Thoracic and Cardiovascular Surgery.

Over 25% of all patients who undergo multivessel revascularization have diabetes. A number of earlier studies have demonstrated that CABG should be the preferred strategy for multivessel revascularization in patients with diabetes. In this group, CABG leads to improved survival rates and a reduced risk of myocardial infarction and repeat revascularization compared with revascularization with PCI.

Coronary artery bypass graft surgery (CABG) remains the most common operation performed by cardiac surgeons today. From its infancy in the 1950s till today, CABG has undergone many developments both technically and clinically.

The study sample consisted of all revascularization procedures in patients with coronary artery disease and having diabetes mellitus from 2010-2018.After propensity matching at 1:1, 552 patients were considered in each cohort (CABG vs. PCI). Post operatively, 30-day, 1-year, and 5-year (median follow-up was 3.28 years) mortality rates of these patients were assessed as standards. The occurrence rates of major adverse cardiovascular and cerebrovascular events (MACCE) were noted in both the CABG and PCI groups .The data obtained was put to statistical analysis.(Multivariable analysis)

Results of the study revealed the followingfacts.

• The PCI cohort has shown relatively high mortality rates at 1-year (13.98% vs 7.53%; p=0.014) and 5-year (26.88% vs. 16.85%; p<0.004).
• Post operatively, readmission rates to hospitals in the PCI group were higher at 1-year (16.49% vs. 9.32%; p<0.0122) and 5-years (19.71% vs. 11.83%; p=0.011).
• Much more frequent occurrences of major adverse cardiovascular and cerebrovascular events (MACCE) in the PCI cohort (32.97% vs. 21.51%; p=0.002).
• The patients in the PCI group finally had to undergo revascularization at a significantly higher rate in comparison to the CABG group. (6.45% vs. 2.51%; p=0.024)
• Researchers also noted that time interval to the second surgical intervention i.e. repeat revascularization was significantly longer in the CABG cohort.

Previous studies for revascularization comparing PCI and CABG have not been able to provide a single solution for the entire spectrum of patients with stable CAD.

Researchers of the present study are of the opinion that CABG results in more complete revascularization than PCI, specifically in complex multivessel CAD, which is common in patients with diabetes. CABG leads to improved survival rates and a reduced risk of myocardial infarction and repeat revascularization compared with revascularization with PCI.

Primary Source

Seminars in Thoracic and Cardiovascular Surgery.

For detailed reading refer to::https://doi.org/10.1053/j.semtcvs.2020.07.003