• Catheter Cardiovasc Interv · Jan 2009

    Comparative Study

    PCI versus CABG for multivessel coronary disease in diabetics.

    • Giuseppe Tarantini, Angelo Ramondo, Massimo Napodano, Enrico Favaretto, Arianna Gardin, Claudio Bilato, Georghios Nesseris, Vincenzo Tarzia, Filippo Cademartiri, Gino Gerosa, and Sabino Iliceto.
    • Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy. giuseppe.tarantini.1@unipd.it
    • Catheter Cardiovasc Interv. 2009 Jan 1; 73 (1): 50-8.

    ObjectivesTo explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in diabetic patients with multivessel disease (MVD) compared with coronary artery bypass graft (CABG), when it is based on clinical judgment.BackgroundDiabetes mellitus (DM) is a major risk factor for poor outcome after PCI. However, PCI may result in better outcome if the choice of revascularization (PCI versus CABG) is based on the physician decision, rather than randomization. Limited experiences have compared revascularization by DES-PCI versus CABG in DM patients with MVD.MethodsFrom August 2004 to August 2005, 220 consecutive DM patients with MVD underwent DES-PCI (93) or CABG (127) at our Institution. The type of revascularization was dependent on patient and/or physician choice. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, repeat coronary revascularization, and stroke.ResultsCompared with PCI patients, CABG patients had higher prevalence of 3-vessel disease (P < 0.001), significant LAD involvement (P < 0.001), presence of total occlusions (P = 0.04), collateral circulation (P < 0.001). At 2-year follow-up, MACCE were not different between CABG group and DES-PCI group (OR 1.2; P = 0.6) and, only when the clinical judgment on the revascularization choice was excluded at propensity analysis, DES-PCI increased the risk of 24-month MACCE in total population (OR 1.8; P = 0.04).ConclusionsFor patients with DM and MVD, a clinical judgment-based revascularization by DES-PCI is not associated with worse 2-year outcome compared with CABG.(c) 2008 Wiley-Liss, Inc.

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