OUTCOME OF CORONARY-BYPASS SURGERY VERSUS CORONARY ANGIOPLASTY IN DIABETIC-PATIENTS WITH MULTIVESSEL CORONARY-ARTERY DISEASE

Objectives. This study sought to compare the outcome of percutaneous t ransluminal coronary angioplasty (PTCA) (n = 834) and coronary artery bypass graft surgery (CABG) (n = 1805) in diabetic patients with multi vessel coronary disease from an observational database, Background. Th ere is concern about selection of revascularization in diabetic patien ts with multivessel coronary artery disease, Methods. Data were collec ted prospectively and entered into a computerized database, Follow up was by letter or telephone or additional events resulting in readmissi on. Results. After CABG there were more in-hospital deaths (0.36%: vs, 4.99%, p < 0.0001) and a trend toward more Q wave myocardial infarcti ons than after PTCA, Five-and 10-year survival rates were 78% and 45% after PTCA and 76% and 48% after CABG, respectively (p = 0.47). At 5 a nd 10 years, insulin-requiring patients had lower survival? rates of 7 2% and 31% after PTCA and 70% and 48% after CABG, respectively (p = 0. 54), Multivariate correlates of long-term mortality were older age, lo w left ventricular ejection fraction, heart failure and hypertension, In the total group, insulin requirement was a correlate of long-term m ortality, For the total group, choice of therapy had a multivariate ha zard ratio close to 1., In the insulin-requiring subgroup, the multiva riate hazard ratio was 1.35 (95% confidence interval 1.01 to 1.79) for PTCA versus CABG, Corrected for baseline differences, 5- and 10-year survival rates were 68% and 36% after PTCA and 75% and 47% after CABG, respectively, in the insulin-requiring subgroup, Nonfatal events were more common after PTCA, especially additional revascularization, Conc lusions. This study reveals a high incidence of events in diabetic pat ients and raises further questions about angioplasty in insulin requir ing diabetic patients with multivessel disease, (C) 1998 by the Americ an College of Cardiology.