Author + information
- Alexander Iribarne,
- Anthony DiScipio,
- Michael Robich,
- Andrew Eisenhauer,
- Bruce Leavitt,
- Yvon Baribeau,
- Peter Ver Lee,
- James Flynn,
- Yi-Ling Huang and
- David Malenka
Background: To assess the comparative effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) among major diabetic subgroups.
Methods: Study design: multi-center, retrospective analysis of all CABGs (n=18,292) and PCIs (n=55,438) from 2004-2014. Inclusion criteria: diabetes, 2 or 3 vessel disease (VD). Exclusion criteria: prior PCI or CABG, left main ≥ 50%, STEMI, or within 24 hours of a MI. Baseline co-morbidities were balanced using inverse probability weighting for a matched cohort of 3,286 CABGs and 3,446 PCIs. Primary end point: all-cause mortality.
Results: The mean duration of follow-up was 4.5 ± 3.2 years. The rate of drug-eluting stent (DES) was 78.8 % (n=2715). Groups were well matched on age, gender, BSA, baseline co-morbidities, number of diseased vessels, and ejection fraction. Compared to PCI, CABG was associated with: improved long-term survival (HR 0.73 [0.66-0.81], p<0.01), decreased risk of repeat revascularization (CABG 3.7% (n=122), PCI 12.5% (n=430), p<0.001), but increased risk of stroke (CABG 0.9% (n=29), PCI 0.09% (n=3), p<0.001). CABG was associated with improved survival across major subgroups of diabetic patients, and the survival advantage was not influenced by era or stent type (Table).
Conclusions: Among patients with diabetes and multi-vessel disease, CABG was associated with greater long-term survival when compared to PCI, and this survival advantage was observed across major patient subgroups.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Complex Coronary Intervention: Left Main/Bifurcations and Multivessel Disease
Abstract Category: 22. Interventional Cardiology: Coronary Intervention: Left Main, Multivessel, Bifurcation
Presentation Number: 1157-190
- 2017 American College of Cardiology Foundation