Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study
Nathaniel W. Niles, MD*,
Paul D. McGrath, MD, FACC ,
David Malenka, MD, FACC*,
Hebe Quinton, MS*,
David Wennberg, MD ,
Samuel J. Shubrooks, MD, FACC ,
Joan F. Tryzelaar, MD,
Robert Clough, MD||,
Michael J. Hearne, MD, FACC¶,
Felix Hernandez, Jr, MD, FACC||,
Matthew W. Watkins, MD, FACC#,
Gerald T. O’Connor, PhD, FACC* for the Northern New England Cardiovascular Disease Study Group
* Department of Medicine and Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Section of Cardiology, Maine Medical Center, Portland, Maine, USA
Maine Medical Assessment Foundation, Augusta, Maine, USA
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
|| Eastern Maine Medical Center, Bangor, Maine, USA
¶ Catholic Medical Center, Manchester, New Hampshire, USA
# Cardiology Unit, Fletcher Allen Health Care, Burlington, Vermont, USA
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Figure 1 A total of 7,159 diabetic patients underwent coronary revascularization procedures between January 1, 1992 and December 31, 1996. Patients were excluded if they: were  80 years of age, had less than two-vessel disease, had undergone prior PCI or CABG, had left main disease (50% stenosis), had emergency procedures or had experienced an acute MI within 24 h before the procedure. The final study population consisted of 2,766 patients with diabetes and MVD and clinical indications for revascularization. Percutaneous intervention was performed on 736 of these patients, and 2,030 patients underwent CABG procedures. CABG = coronary artery bypass grafting; MI = myocardial infarction; MVD = multivesssel coronary artery disease; PCI = percutaneous coronary intervention.
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Figure 2 Five-year Kaplan-Meyer survival according to revascularization strategy after adjusting for differences in baseline characteristics: age, gender, ejection fraction, left ventricular end-diastolic pressure, procedural priority, comorbid conditions (chronic obstructive pulmonary disease requiring bronchodilator therapy, renal failure on dialysis or peripheral vascular disease) and the proportion of patients with three-vessel disease. CABG = coronary artery bypass grafting; HR = hazard ratio; PCI = percutaneous coronary intervention.
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Figure 3 Five-year Kaplan-Meyer survival for 1,251 patients with diabetes and three-vessel disease and 1,515 with diabetes and two-vessel disease revascularized initially with CABG or PCI after adjusting for differences in baseline characteristics (age, gender, ejection fraction, left ventricular end-diastolic pressure, procedural priority and comorbid conditions: chronic obstructive pulmonary disease requiring bronchodilator therapy, renal failure on dialysis or peripheral vascular disease). CABG = coronary artery bypass grafting; HR = hazard ratio; PCI = percutaneous coronary intervention.
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Figure 4 Hazard ratios (and 95% confidence intervals) at five- to six-year follow-up for initial PCI compared with CABG among patients with diabetes and multivessel disease estimated from three single-institution database studies, the BARI registry, the current NNE and the BARI randomized trial. All hazard ratios are adjusted except where indicated by asterisks. BARI = Bypass-Angioplasty Revascularization Investigation; CABG = coronary artery bypass grafting; DM = diabetes mellitus; HR = hazard ratio; MAHI = Mid America Heart Institute; NNE = Northern New England database study; PCI = percutaneous coronary intervention; 3VD = three-vessel disease.
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