Author + information
- Received September 12, 2017
- Revision received November 14, 2017
- Accepted December 11, 2017
- Published online February 19, 2018.
- Jeevan Nagendran, MD, PhDa,b,
- Sabin J. Bozso, MDa,
- Colleen M. Norris, PhDa,b,
- Finlay A. McAlister, MD, MScc,
- Jehangir J. Appoo, MDCMd,
- Michael C. Moon, MDa,b,
- Darren H. Freed, MD, PhDa,b,e and
- Jayan Nagendran, MD, PhDa,b,e,∗ ()
- aDivision of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- bMazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
- cDivision of General Internal Medicine and Patient Health Outcomes Research and Clinical Effectiveness Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- dDivision of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- eAlberta Transplant Institute, Edmonton, Alberta, Canada
- ↵∗Address for correspondence:
Dr. Jayan Nagendran, Division of Cardiac Surgery, Department of Surgery, University of Alberta and Mazankowski Alberta Heart Institute, 4-108A Li Ka Shing Health Research Centre, 8602 112 Street, Edmonton, Alberta T6G 2E1, Canada.
Background The role of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) has been established by large trials; however, these trials largely excluded patients with left ventricular dysfunction (LVD).
Objectives The aim of this study was to determine whether treatment with PCI or CABG leads to improved outcomes in patients with DM, CAD, and LVD.
Methods In this propensity-matched study, outcomes were compared for patients with CAD, DM, and LVD treated with PCI or CABG between 2004 and 2016. The primary outcome was major adverse cardiac and cerebrovascular events, defined as the composite of death, stroke, myocardial infarction, and repeat revascularization. Secondary outcomes were the individual components of the primary outcome.
Results PCI compared with CABG was associated with a higher risk for major adverse cardiac and cerebrovascular events in cohorts with ejection fraction (EF) 35% to 49% (p < 0.001) and <35% (p < 0.001). Treatment with PCI was associated with an increased risk for death in both the EF 35% to 49% and the EF <35% cohorts. Stroke rate did not differ between PCI and CABG in either EF cohort. PCI was associated with an increased rate of MI in the EF <35% cohort, and repeat revascularization occurred more frequently in patients treated with PCI in both the EF 35% to 49% cohort and the EF <35% cohort.
Conclusions At long-term follow-up, patients with CAD, DM, and LVD treated with CABG exhibited a significantly lower incidence of major adverse cardiac and cerebrovascular events and better long-term survival over PCI, without a higher risk for stroke.
The University Hospital Foundation and the Alberta Strategy for Patient Oriented Research are jointly funded by Alberta Innovates and the Canadian Institute of Health Research. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 12, 2017.
- Revision received November 14, 2017.
- Accepted December 11, 2017.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.