Twelve months clinical outcome of drug-eluting stents implantation or coronary artery bypass surgery for the treatment of diabetic patients with multivessel disease.

BACKGROUND

Studies comparing coronary artery bypass grafting (CABG) with drug-eluting stent (DES) for the treatment of diabetic patients with multivessel disease are relatively scarce although controversies exist concerning the relative efficacy of CABG versus DES.

HYPOTHESIS

The aim of this study was to evaluate the effect of drug-eluting stent (DES) implantation in diabetic patients with multivessel disease compared with CABG.

METHODS

We included 645 consecutive diabetic patients who underwent either CABG (n = 282) or DES implantation (n = 363) in our institution from July 2003 to December 2005.

RESULTS

At 12 mo after index revascularization procedure, the total mortality rate was similar in the CABG and DES group (3.2% versus 3.0%, hazard ratio [HR] of CABG versus percutaneous coronary intervention [PCI] 0.58, 95% confidence interval [CI]: 0.14 to 2.45, p = 0.460), but the rate of major adverse cardiac cerebrovascular events was lower in the CABG group (7.8% versus 17.9%, HR: 0.15, 95% CI: 0.06 to 0.37, p < 0.001) mainly due to less repeat revascularization with CABG (1.4% versus 11.6%, HR: 0.02, 95% CI: 0.01 to 0.13, p < 0.001). Age, 3-vessel disease, and serum creatinine > or =1.5 mg/dl were positive independent predictors of 12 mo death.

CONCLUSIONS

At 12 mo, CABG was associated with less adverse events primarily due to less repeat revascularization compared with DES although there was no significant difference in mortality and myocardial infarction (MI) rates between the 2 groups; high repeat revascularization rate related to DES resulted from high restenosis rate in diabetic patients and lower rate of complete revascularization offered by PCI.