• Int. J. Cardiol. · Sep 2013

    Multicenter Study

    Five-year outcomes of surgical or percutaneous myocardial revascularization in diabetic patients.

    • Giovanni Andrea Contini, Francesco Nicolini, Daniela Fortuna, Davide Pacini, Davide Gabbieri, Luigi Vignali, Marco Valgimigli, Antonio Manari, Claudio Zussa, Paolo Guastaroba, Rossana De Palma, Roberto Grilli, and Tiziano Gherli.
    • Unità Operativa di Cardiochirurgia, Dipartimento Cardio-nefro-polmonare, Azienda Ospedaliero-Universitaria di Parma, Italy. Electronic address: acontini@ao.pr.it.
    • Int. J. Cardiol. 2013 Sep 30;168(2):1028-33.

    BackgroundThe study compares five-year clinical outcomes of CABG vs PCI in a real world population of diabetic patients with multivessel coronary disease since it is not clear whether to prefer surgical or percutaneous revascularization.MethodsBetween July 2002 and December 2008, 2885 multivessel coronary diabetic patients underwent revascularization (1466 CABG and 1419 PCI) at hospitals in Emilia-Romagna Region, Italy and were followed for 1827 ± 617 days by record linkage of two clinical registries with the regional administrative database of hospital admissions and the mortality registry. Five-year incidences of MACCE (mortality, acute myocardial infarction [AMI], stroke, and repeat revascularization [TVR]) were assessed with Kaplan-Meier estimates, Cox proportional hazards regression and cumulative incidence functions of death and TVR, to evaluate the competing risk of AMI on death and TVR. The same analyses were applied to the propensity score matched subgroup of patients undergoing CABG or PCI with DES and with complete revascularization.ResultsPCI had higher mortality for all causes (HR: 1.8, 95% CI 1.4-2.2 p<0.0001), AMI (HR: 3.3, 95% CI 2.4-4.6 p<0.0001) and TVR (HR: 4.5, 95% CI 3.4-6.1 p<0.0001). No significant differences emerged for stroke (HR: 0.8, 95% CI 0.5-1.2 p=0.26). The higher incidence of AMI caused higher mortality in PCI group. Results did not change comparing CABG with PCI patients receiving complete revascularization or DES only.ConclusionsDiabetics show a higher incidence of MACCE with PCI than with CABG: thus diabetes and its degree of control should be considered when choosing the type of revascularization.Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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