LONG-TERM OUTCOMES OF MYOCARDIAL REVASCULARIZATION IN DIABETIC PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE
Background: The optimal strategy of revascularization in patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) is not clearly defined.
Aim: To compare the long-term results of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with multivessel CAD with and without DM.
Methods: 406 patients with low and intermediate Syntax scores (SS) underwent PCI with drug-eluting stents (n=200, 100 with SS ≤22 and 100 with SS 23-32), and CABG (n=206, 100 with SS≤22 and 106 with SS 23-32). Patients were also stratified by diabetes status: 134 patients with DM and 272 patients without diabetes. The mean follow-up period was 9±1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events (МАССЕ), a repeat revascularization, diminished left ventricular ejection fraction (LVEF), and high SS (≥33) in dynamics.
Results: For patients with DM, neither PCI nor CABG showed advantages in terms of the main indicators of МАССЕ (76% vs. 63%; HR: 1.1; CI: 0.8 - 1.7; p = 0.55). For patients with insulin-requiring DM, PCI showed an advantage over CABG in terms of overall mortality (14% vs. 52%; HR 0.3; CI 0.1- 1; p=0.048, respectively). DM significantly influenced the progression of coronary atherosclerosis in both general cohort and PCI and CABG groups.
Conclusions: For patients with DM and multivessel CAD, neither PCI nor CABG showed advantages in terms of the main indicators of МАССЕ. For patients with insulin-requiring DM, PCI showed superiority over CABG in terms of all-cause mortality.
Maira I. Madiyeva1, https://orcid.org/0000-0002-6789-5852
Marat A. Aripov2, https://orcid.org/0000-0003-2413-5818
Alexey Y. Goncharov3, https://orcid.org/0000-0002-0998-1461
Rakhima Y. Zholdasbekova4, https://orcid.org/0000-0002-0235-0560
Zere Z. Karimova5, https://orcid.org/0000-0002-4993-3720
Jamilya A. Мansurova6, https://orcid.org/0000-0003-2439-2056
1,6 NJSC «Semey Medical University», Semey, Republic of Kazakhstan;
2,3 National Research Cardiac Surgery Center, Department of Interventional Cardiology, Astana, Republic of Kazakhstan;
4 Pavlodar Branch, NJSC «Semey Medical University», Pavlodar, Republic of Kazakhstan;
5 Pavlodar Regional Cardiology Center, Pavlodar, Republic of Kazakhstan.
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Madiyeva M.I., Aripov M.A., Goncharov A.Y., Zholdasbekova R.Y., Karimova Z.Z., Мansurova J.A. Long-term outcomes of myocardial revascularization in diabetic patients with multivessel coronary artery disease // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 2, pp. 70-78. doi 10.34689/SH.2023.25.2.010Related publications:
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