Godoy Lucas C, Fuster Valentin, Razzouk Louai, Dangas George, Sethi Sanjum S, Sidhu Mandeep S, Rodriguez Alfredo E, Solomon Scott D, Farkouh Michael E
Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Instituto do Coração (InCor), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
Ann Thorac Surg. 2025 Jun;119(6):1251-1260. doi: 10.1016/j.athoracsur.2024.12.013. Epub 2024 Dec 24.
In patients with diabetes and multivessel coronary artery disease, percutaneous coronary intervention (PCI) has been associated with higher long-term cardiovascular mortality compared with coronary artery bypass grafting (CABG), but the specific causes of death are not well known. We aimed to determine the causes of death of patients with diabetes and multivessel disease undergoing coronary revascularization with PCI vs CABG.
We analyzed the centrally adjudicated causes of death of 1900 participants in the FREEDOM trial. Cause-specific hazard ratios (csHRs) were used to compare mortality rates.
There were 197 deaths during the 5 years of follow-up; 63.5% were classified as cardiovascular deaths and the remaining (36.5%), noncardiovascular deaths. Sudden cardiac death was the most common cause of cardiovascular mortality (40% of all cardiovascular deaths), followed by myocardial infarction deaths (16% of all cardiovascular deaths). Compared with CABG, PCI was associated with increased ischemia-related mortality, namely, sudden cardiac death (csHR, 2.04; 95% CI, 1.13-3.70; P = .02) and the composite of sudden cardiac death and myocardial infarction death (csHR, 2.10; 95% CI, 1.27-3.48, P = .004). PCI was associated with a nonsignificant increase in overall cardiovascular mortality compared with CABG (csHR, 1.35; 95% CI, 0.95-1.93; P = .09).
Sudden cardiac death was the most common cause of long-term mortality of patients with diabetes and multivessel coronary artery disease undergoing a revascularization procedure. Compared with CABG, PCI was associated with increased long-term rates of ischemia-related mortality. Operative techniques and secondary prevention should target reducing post-revascularization spontaneous myocardial infarction in patients treated with PCI.
在患有糖尿病和多支冠状动脉疾病的患者中，与冠状动脉搭桥术（CABG）相比，经皮冠状动脉介入治疗（PCI）与更高的长期心血管死亡率相关，但具体死因尚不清楚。我们旨在确定接受PCI与CABG进行冠状动脉血运重建的糖尿病和多支血管疾病患者的死亡原因。
我们分析了FREEDOM试验中1900名参与者经中央裁定的死亡原因。使用特定病因风险比（csHRs）来比较死亡率。
在5年的随访期间有197例死亡；63.5%被归类为心血管死亡，其余（36.5%）为非心血管死亡。心源性猝死是心血管死亡的最常见原因（占所有心血管死亡的40%），其次是心肌梗死死亡（占所有心血管死亡的16%）。与CABG相比，PCI与缺血相关死亡率增加有关，即心源性猝死（csHR，2.04；95%CI，1.13 - 3.70；P = 0.02）以及心源性猝死和心肌梗死死亡的复合情况（csHR，2.10；95%CI，1.27 - 3.48，P = 0.004）。与CABG相比，PCI与总体心血管死亡率的非显著增加有关（csHR，1.35；95%CI，0.95 - 1.93；P = 0.09）。
心源性猝死是接受血运重建手术的糖尿病和多支冠状动脉疾病患者长期死亡的最常见原因。与CABG相比，PCI与缺血相关死亡率的长期增加有关。手术技术和二级预防应旨在降低接受PCI治疗患者血运重建后的自发性心肌梗死发生率。
