Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients - Insights from theArterial Revascularization Therapy Study (ARTS) trial

Background-Our aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel corona ry disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies. Methods and Results-Patients (n=1205) were randomly assigned to stent impla ntation (n=600; diabetic, 112) or CABG (n=605; diabetic, 96). Costs per pat ient were calculated as the product of each patient's use of resources and the corresponding unit costs. Baseline characteristics were similar between the groups. At I year, diabetic patients treated with stenting had the low est event-free survival rate (63.4%) because of a higher incidence of repea t revascularization compared with both diabetic patients treated with CABG (84.4%, P<0.001) and nondiabetic patients treated with stents (76.2%, P=0.0 4). Conversely, diabetic and nondiabetic patients experienced similar 1-yea r event-free survival rates when treated with CABG (84.4% and 88.4%). The t otal 1-year costs for stenting and CABG in diabetic patients were $12 855 a nd $16 585 (P<0.001) and in the nondiabetic groups, $10 164 for stenting an d $13 082 for surgery. Conclusions-Multivessel diabetic patients treated with stenting had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting. The strategy of stenting was less costly than CABG, however, reg ardless of diabetic status.