BYPASS-SURGERY VERSUS CORONARY ANGIOPLASTY FOR REVASCULARIZATION OF TREATED DIABETIC-PATIENTS

Background The purpose of this study was to evaluate outcomes after co ronary bypass surgery versus coronary angioplasty in 525 patients with pharmacologically treated diabetes. Diabetic patients constitute a si gnificant portion of patients considered for coronary revascularizatio n.;Some studies have shown no difference in long-term outcome when com paring revascularization mode. Recently, the Bypass Angioplasty Revasc ularization Investigation reported better survival with bypass surgery over angioplasty in treated diabetic patients. However, the above stu dies have been limited by small cohorts of diabetic patients. Methods and Results By using a single-institution comprehensive database, a re trospective cohort design was used to study 525 consecutive pharmacolo gically treated diabetic patients who underwent coronary revasculariza tion. Patients treated with surgery (n=246) were statistically similar when comparing age, gender, angina class, and ejection fraction to pa tients (n=279) treated with angioplasty. Follow-up was complete in 95% of bypass patients and 99% of angioplasty patients. Mean follow-up wa s 55.5 months. Complete revascularization was accomplished more often in the surgery group (79%) than in the angioplasty group (42%; P<.001) . During a 6-year follow-up, repeat revascularization (8% versus 64%; P=.001), cardiac events (32% versus 41%; P=.04), and death (30% versus 37%; P=.08) occurred less in the bypass patients than the angioplasty patients. Multivariable analysis identified age >70 years, ejection f raction <40%, class IV angina, and incomplete revascularization, but n ot mode of revascularization, as correlates of late mortality. Conclus ions For most pharmacologically treated diabetic patients, freedom fro m death, myocardial infarction, and subsequent revascularization durin g long-term follow-up is superior with bypass surgery compared with an gioplasty. This worse outcome was mediated in part by the frequent occ urrence of incomplete revascularization with angioplasty.