Survival of patients with diabetes and multivessel coronary artery diseaseafter surgical or percutaneous coronary revascularization: Results of a large regional prospective study

OBJECTIVES We sought to assess survival among patients with diabetes and mu ltivessel coronary artery disease (MVD) after percutaneous coronary interve ntion (PCI) and after coronary artery bypass grafting surgery (CABG). BACKGROUND The Bypass Angioplasty Revascularization Investigation (BARI) de monstrated that diabetics with MVD survive longer after initial CABG than a fter initial PCI. Other randomized trials or observational databases have n ot conclusively reproduced this result. METHODS A large, regional database was linked to the National Death Index t o assess five-year mortality. Of 7,159 consecutive patients with diabetes w ho underwent coronary revascularization in northern New England during 1992 to 1996, 2,766 (38.6%) were similar to those randomized in the BARI trial. Percutaneous coronary intervention was the initial revascularization strat egy in 736 patients and CABG in 2,030. Cox proportional hazards regression was used to calculate risk-adjusted hazard ratios (HR) and 95% confidence i ntervals (CI 95%). RESULTS Patients who underwent PCI were younger, had higher ejection fracti ons and less extensive coronary disease. After adjusting inr differences in baseline clinical characteristics, patients with diabetes treated with PCI had significantly greater mortality relative to those undergoing CABG (HR = 1.49; CI 95%: 1.02 to 2.17; p = 0.037). Mortality risk tended to increase more among 1,251 patients with 3VD (HR = 2.02; CI 95%: 1.04 to 3.91; p = 0 .038) than among 1,515 patients with 2VD (HR = 1.33; CI 95%: 0.84 to 2.1; p = 0.21). CONCLUSIONS In this analysis of a large regional contemporary database of p atients with diabetes selected to be similar to those enrolled in the BARI trial, five-year mortality was significantly increased after initial PCI. T his supports the BARI conclusion on initial revascularization of patients w ith diabetes and MVD. (J Am Coll Cardiol 2001;37:1008-15) (C) 2001 by the A merican College of Cardiology.