RELATIONSHIP BETWEEN DIABETES-MELLITUS AND LONG-TERM SURVIVAL AFTER CORONARY-BYPASS AND ANGIOPLASTY

Background Recent subgroup analyses of randomized trials have suggeste d that percutaneous intervention in diabetic patients with multivessel disease results in higher mortality than coronary artery bypass graft surgery (CABG). We studied the relationship between diabetes and surv ival after revascularization in a large prospective cohort of patients with multivessel coronary artery disease. Methods and Results By anal yzing data for 3220 patients (24% diabetic) with symptomatic two- or t hree-vessel coronary disease who were undergoing percutaneous translum inal coronary angioplasty (PTCA) or CABG at Duke University Medical Ce nter between 1984 and 1990, we found that at 5 years, unadjusted survi val in the group of patients undergoing CABG was 74% in diabetics and 86% in nondiabetics. Similarly, 5-year survival among PTCA patients wa s 76% in diabetics and 88% in patients without diabetes. After adjustm ent for baseline characteristics, diabetic patients receiving either P TCA or CABG had significantly poorer survival than nondiabetics (chi(2 )=43.56, P<.0001). Unlike previous studies, however, there was no sign ificant differential effect of diabetes on outcome between patients tr eated with PTCA and those treated with CABG (chi(2)=0.01, P=.91). Conc lusions Although diabetes was associated with a worse long-term outcom e after both PTCA and CABG in patients with multivessel coronary arter y disease, the effect of diabetes on prognosis was similar in both tre atment groups. Thus, our findings support the concept that the choice of initial revascularization strategy should not be based exclusively on a history of diabetes but rather should rely on other factors, such as angiographic suitability and clinical status.