Department of Cardiology, Xijing Hospital, Changle West Road 127, Xi'an 710032, China.
Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.
Eur Heart J. 2021 Dec 28;43(1):56-67. doi: 10.1093/eurheartj/ehab441.
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.
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).
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.
SYNTAX: ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.
本文旨在比较接受冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）的糖尿病患者与非糖尿病患者 10 年后全因死亡率。
SYNTAXES 研究评估了 1800 例三血管疾病（3VD）和/或左主干冠状动脉疾病（LMCAD）患者的 10 年生存情况，这些患者在 SYNTAX 试验中随机接受 PCI 或 CABG 治疗。根据糖尿病状态和血运重建策略，观察 10 年全因死亡率。在糖尿病患者（n=452）中，5 年时 PCI 组的死亡率明显高于 CABG 组[19.6%比 13.3%，风险比（HR）：1.53，95%置信区间（CI）：0.96，2.43，P=0.075]，但 5 至 10 年时则相反（PCI 组比 CABG 组：20.8%比 24.4%，HR：0.82，95%CI：0.52，1.27，P=0.366）。无论糖尿病状态如何，接受 PCI 或 CABG 治疗的患者 10 年全因死亡率无显著差异，糖尿病患者的绝对治疗差异为 1.9%（PCI 组比 CABG 组：36.4%比 34.5%，差异：1.9%，95%CI：-7.6%，11.1%，P=0.551）。在胰岛素治疗患者（n=182）中，10 年时 PCI 组的全因死亡率明显更高（47.9%比 39.6%，差异：8.2%，95%CI：-6.5%，22.5%，P=0.227）。
无论是否存在糖尿病，3VD 和/或 LMCAD 患者接受 PCI 与 CABG 治疗的 10 年全因死亡率的治疗效果相似。然而，对于胰岛素治疗的糖尿病患者，CABG 可能具有生存获益。需要在专门的试验中进一步研究糖尿病患者的血运重建策略与极长缺血和安全性结局之间的关系。
SYNTAX：ClinicalTrials.gov 参考号：NCT00114972 和 SYNTAX 扩展生存：ClinicalTrials.gov 参考号：NCT03417050。
