Long-term outcomes after percutaneous coronary intervention relative to bypass surgery in diabetic patients with multivessel coronary artery disease according to clinical presentation

Yong Joon Lee, Sung Jin Hong, Byeong Keuk Kim, Sanghoon Shin, Yongsung Suh, Seunghwan Kim, Chul Min Ahn, Jung Sun Kim, Young Guk Ko, Donghoon Choi, Myeong Ki Hong, Yangsoo Jang

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2 Citations (Scopus)


Background For diabetic patients with multivessel coronary artery disease (MVD), limited data exist on the long-term outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) according to clinical presentation [stable coronary artery disease (SCAD) or non-ST-elevation acute coronary syndrome (NSTE-ACS)]. Patients and methods From a Korean multicenter registry, we analyzed 1135 diabetic patients with MVD treated with PCI (n = 660) or CABG (n = 475). After propensity score matching, 8-year major adverse cardiovascular and cerebrovascular events [MACCE; composite of all-cause death, myocardial infarction (MI), or stroke] were compared between PCI and CABG according to clinical presentation. Results After matching, MACCE was not different between PCI and CABG for SCAD patients [15.6 vs. 17.2%, hazard ratio (HR) = 0.94, 95% confidence interval (CI) = 0.55-1.63, P = 0.837], whereas it was higher in PCI than in CABG for NSTE-ACS patients (31.1 vs. 22.4%, HR = 1.63, 95% CI = 1.03-2.59, P = 0.036), mainly driven by the higher MI occurrence (HR = 2.18, 95% CI = 1.04-4.59, P = 0.035). A significant interaction between revascularization strategy and clinical presentation was observed for MACCE (P-interaction = 0.022). However, when PCI was further classified according to revascularization completeness, the treatment gap between PCI and CABG with respect to MI in NSTE-ACS patients was improved by complete-revascularization PCI. Conclusion Among diabetic patients with MVD, the long-term outcomes of PCI versus CABG differed according to clinical presentation. CABG may be more beneficial for NSTE-ACS patients with MVD in reducing MACCE and MI, whereas PCI was as effective as CABG for SCAD patients with MVD. Therefore, clinical presentation must be considered when choosing revascularization strategies in these patients.

Original languageEnglish
Pages (from-to)174-183
Number of pages10
JournalCoronary artery disease
Issue number2
Publication statusPublished - 2020 Mar 1

Bibliographical note

Funding Information:
This research was supported by a grant from the Korean Society of Interventional Cardiology, Republic of Korea (no. 2015-1); the Korea Healthcare Technology Research and Development Project, Ministry for Health and Welfare,Republic of Korea (nos A085136 and HI15C1277); the Mid-career Researcher Program through a National Research Foundation grant by the Ministry of Education, Science and Technology, Republic of Korea (grant number: 2015R1A2A2A01002731); and the Cardiovascular Research Center, Seoul, Republic of Korea.

Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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