Comparison of survival following coronary artery bypass grafting vs. percutaneous coronary intervention in diabetic and non-diabetic patients: retrospective cohort study of 6320 procedures

Aim  To determine whether mortality following percutaneous coronary intervention vs. coronary bypass grafting varies according to whether or not patients have diabetes. Methods  We used the Scottish Coronary Revascularization Register to identify all patients undergoing revascularization in Scottish...

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Bibliographic Details
Published in:Diabetic medicine 2004-07, Vol.21 (7), p.790-792
Main Authors: Pell, J. P., Pell, A. C. H., Jeffrey, R. R., Jennings, K., Oldroyd, K., Eteiba, H., Hogg, K. J., Murday, A., Faichney, A., Colquhoun, I., Berg, G., Starkey, I. R., Flapan, A., Mankad, P.
Format: Article
Language:English
Subjects:
Aged
angioplasty
Angioplasty, Balloon, Coronary - mortality
Biological and medical sciences
coronary artery bypass
Coronary Artery Bypass - mortality
Coronary Disease - mortality
Coronary Disease - surgery
Coronary Disease - therapy
diabetes mellitus
Diabetes. Impaired glucose tolerance
Diabetic Angiopathies - mortality
Diabetic Angiopathies - surgery
Diabetic Angiopathies - therapy
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Female
Humans
Male
Medical sciences
Middle Aged
mortality
percutaneous coronary
Proportional Hazards Models
Retrospective Studies
Scotland - epidemiology
transluminal
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Summary:Aim  To determine whether mortality following percutaneous coronary intervention vs. coronary bypass grafting varies according to whether or not patients have diabetes. Methods  We used the Scottish Coronary Revascularization Register to identify all patients undergoing revascularization in Scottish NHS hospitals since 1997. We excluded single‐vessel disease, left main stem stenosis, and bypass grafting performed at the same time as other operations. We used death certificate data from the Registrar General to identify all subsequent deaths. Results  Of the 6320 eligible procedures, 5042 (80%) were bypass grafts and 1278 (20%) angioplasties. Overall 831 (13%) patients had diabetes with no significant difference by procedure (13% vs. 12%). A total of 382 deaths occurred over a mean follow‐up of 2.3 years. Diabetic patients had a poorer prognosis following both surgery (adjusted hazards ratio (HR) 1.43, 95% confidence interval (CI) 1.08, 1.89) and percutaneous intervention (adjusted HR 2.58, 95% CI 1.43, 4.63). Among non‐diabetic patients, no significant differences in mortality were detected between the two procedures. Among diabetic patients, no significant difference was detected in those with two‐vessel disease. In those with impaired left ventricular function and triple‐vessel disease, angioplasty was associated with a significantly higher risk of death (adjusted HR 3.58, 95% CI 1.40, 9.19). Conclusions  This is the first study to demonstrate statistically significant results that support the BARI trial findings. Our study demonstrated a significant difference for triple‐vessel disease but not two‐vessel disease. The former may be due to incomplete revascularization using percutaneous intervention. Our results require corroboration from randomized trials.
ISSN:0742-3071
1464-5491
DOI:10.1111/j.1464-5491.2004.01171.x