Saeed Afridi Muhammad, Shehzad Roomi Faisal, Kashif Khan Hafiz Muhammad, Kazim Awais Hussain, Afridi Rimsha Saeed, Usmani Sauda, Ali Sheikh Sabahat, Khan Fahad R
Cardiac Surgery, Rashid Latif Khan University (RLKU) Medical College, Lahore, PAK.
Cardiac Surgery, Chaudhary Pervaiz Elahi Institute of Cardiology, Wazirabad, PAK.
Cureus. 2024 Aug 5;16(8):e66166. doi: 10.7759/cureus.66166. eCollection 2024 Aug.
Background Coronary artery disease (CAD) significantly contributes to morbidity and mortality globally, particularly in individuals with diabetes mellitus, who are at a heightened risk for cardiovascular complications. The complexity of coronary lesions and diffuse atherosclerosis in diabetic patients presents challenges in their treatment and prognosis. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are primary revascularization strategies for managing multi-vessel CAD in diabetic patients. Despite advancements in both techniques, their relative efficacy and safety remain debated, especially in the diabetic population. Objective This multicenter study aims to compare the long-term outcomes of CABG and PCI in diabetic patients with multi-vessel CAD. The primary endpoints include overall survival and the incidence of major adverse cardiac events (MACE). Secondary endpoints encompass revascularization success and procedural complication rates. Methods This retrospective cohort study was conducted across multiple centers, and the research spanned from January 2020 to December 2021. A total of 500 diabetic patients with multi-vessel CAD were included: 250 underwent CABG and 250 received PCI. Data were collected from electronic health records, capturing demographic details, clinical characteristics, procedural specifics, and follow-up outcomes over 24 months. Statistical analyses were performed using SPSS version 25 (IBM Corp., Armonk, NY), including Kaplan-Meier survival curves and Cox proportional hazards regression. Results The mean age of participants was 60.3 ± 10.5 years, with males constituting 52% of each group. Both groups achieved a high revascularization success rate of 90%. The CABG group treated more vessels on average (2.3 ± 0.7) compared to the PCI group (1.9 ± 0.8) (p < 0.001). Survival rates were higher in the CABG group (88%) compared to the PCI group (82%) (p = 0.08). MACE incidence was lower in the CABG group (22%) compared to the PCI group (28%) (p = 0.10). Procedural complications were marginally higher in the CABG group (16%) than in the PCI group (14%) (p = 0.60). Conclusion Both CABG and PCI are effective revascularization options for diabetic patients with multi-vessel CAD. CABG may offer a slight advantage in long-term survival and reduction in MACE, although the differences were not statistically significant. These findings suggest that individualized treatment strategies should be considered to optimize patient outcomes.
冠状动脉疾病（CAD）在全球范围内对发病率和死亡率有显著影响，尤其是在糖尿病患者中，他们发生心血管并发症的风险更高。糖尿病患者冠状动脉病变的复杂性和弥漫性动脉粥样硬化给其治疗和预后带来了挑战。冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）是治疗糖尿病患者多支血管CAD的主要血运重建策略。尽管这两种技术都有进展，但它们的相对疗效和安全性仍存在争议，尤其是在糖尿病患者群体中。
本多中心研究旨在比较CABG和PCI治疗多支血管CAD糖尿病患者的长期结局。主要终点包括总生存率和主要不良心脏事件（MACE）的发生率。次要终点包括血运重建成功率和手术并发症发生率。
本回顾性队列研究在多个中心进行，研究时间跨度为2020年1月至2021年12月。共纳入500例多支血管CAD糖尿病患者：250例行CABG，250例接受PCI。从电子健康记录中收集数据，记录人口统计学细节、临床特征、手术细节以及24个月的随访结局。使用SPSS 25版（IBM公司，纽约州阿蒙克）进行统计分析，包括Kaplan-Meier生存曲线和Cox比例风险回归。
参与者的平均年龄为60.3±10.5岁，每组男性占52%。两组的血运重建成功率均高达90%。CABG组平均治疗的血管数（2.3±0.7）多于PCI组（1.9±0.8）（p<0.001）。CABG组的生存率（88%）高于PCI组（82%）（p=0.08）。CABG组的MACE发生率（22%）低于PCI组（28%）（p=0.10）。CABG组的手术并发症发生率（16%）略高于PCI组（14%）（p=0.60）。
CABG和PCI都是治疗多支血管CAD糖尿病患者有效的血运重建选择。CABG在长期生存和降低MACE方面可能略有优势，尽管差异无统计学意义。这些发现表明应考虑个体化治疗策略以优化患者结局。
