Ten-year all-cause death after percutaneous or surgical revascularization in diabetic patients with complex coronary artery disease

Abstract

Aims The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes. Methods and results The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: −7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: −6.5%, 22.5%, P = 0.227). Conclusions The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials. Trial registration SYNTAX: ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.

Type 2 Diabetes Increases Risk of Unfavorable Survival Outcome for Postoperative Ischemic Stroke in Patients Who Underwent Non-cardiac Surgery: A Retrospective Cohort Study

“…Advanced age, malignant tumor surgery, LHI, HbA 1c level, and the follow-up time were associated with shortened OS in several previous meta-analyses or studies (Sheth et al, 2018;GBD 2019 Diseases andInjuries Collaborators, 2020;Wang et al, 2021). Thus, we performed subgroup analysis according to age, malignant tumor surgery, LHI, HbA 1c level, and the followup time to explore the potential interaction.…”

A multi-center, randomized, double-blinded, parallel, placebo-controlled study to assess the efficacy and safety of Shenqisuxin granule in complex coronary artery disease after PCI: Study protocol

“…The treatment for CCAD appears to be trapped. Currently, most studies on CCAD have focused on the strategies and medical devices for revascularization, including preferential choice of PCI or coronary artery bypass grafting (CABG), novel supreme drug-eluting stents, intravascular ultrasoundguided treatment, etc., (25,(35)(36)(37). Even with the help of stateof-the-art revascularization, the improvement in myocardial ischemia is usually regional and limited.…”

Modifiers of the Risk of Diabetes for Long-Term Outcomes After Coronary Revascularization

“… 22 , 23 However, no clear interactions between diabetes status and effects of mode of revascularization on long-term clinical outcomes were reported in the recent RCTs. 24 , 25 , 26 , 27 According to the collaborative analysis of 11 RCTs, the rate of 5-year mortality among patients with diabetes was significantly higher in the PCI arm than in the CABG arm (HR: 1.44; 95% CI: 1.20-1.74; P < 0.001), whereas no significant difference was observed between PCI and CABG among patients without diabetes (HR: 1.02; 95% CI: 0.86-1.21; P = 0.81, P interaction = 0.008). 28 The intention of the collaborative analysis was not to explore difference in the magnitude of excess risk of diabetes relative to nondiabetes by mode of revascularization; nevertheless, we could infer that the magnitude of excess mortality risk of diabetes relative to nondiabetes was greater among patients who underwent PCI than in those who underwent CABG.…”