Scudeler Thiago L, Alves da Costa Leandro M, de Oliveira Silva Filho José Roberto, Belo Nunes Rafael Amorim, Schneidewind Rafael Otto, Brito Thiago Midlej, Genta Pereira Daniel Castanho, de Oliveira Roger Pereira, Santana Gabriela Chaves, Schainberg Rodrigo Goldenstein, Gori Montes Anna Beatriz, Cordeiro de Paula Leonardo Jorge, Valverde Akamine Marco Alexander, Castello Helio, de Carvalho Cantarelli Marcelo José, Junior Álvaro Avezum
Department of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Mayo Clin Proc Innov Qual Outcomes. 2025 Apr 16;9(3):100604. doi: 10.1016/j.mayocpiqo.2025.100604. eCollection 2025 Jun.
To compare the outcomes of diabetic patients hospitalized with non-ST-elevation myocardial infarction (NSTEMI) referred for coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in a real-world evidence population.
This study assessed major cardiovascular outcomes in diabetic patients who underwent myocardial revascularization, using data obtained on July 24, 2024, from TriNetX, a global health research network. Patients with diabetes mellitus and NSTEMI were identified using the International Classification of Diseases, Tenth Revision, diagnosis code. Main outcome measure was 5-year all-cause mortality. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patients.
A total of 18,115 patients with a mean age of 62.2 (SD, 8.98) years and a mean glycated hemoglobin A1c of 7.66% (SD, 2.18%) were included, of whom 8206 (45.3%) underwent CABG and 9909 (54.7%) underwent PCI. During the 5-year follow-up, 2275 (12.5%) deaths were recorded in all cohort. Propensity matching yielded a 1:1 match consisting of 7585 patients in each group (CABG vs PCI); CABG was associated with significantly lower all-cause mortality over 5 years of follow-up (10.6% vs 17.9%; hazard ratio, 0.685; 95% CI, 0.618-0.759; <.0001). Myocardial infarction occurred more frequently in the PCI cohort (48.6% vs 43.3%; <.0001). Additional coronary revascularization was higher for PCI patients at 5 years (14.5% vs 1.72%; =.0229).
In this real-world study of diabetic patients with NSTEMI, CABG was associated with a lower rate of all-cause mortality at 5 years when compared with PCI.
在真实世界证据人群中比较因非ST段抬高型心肌梗死（NSTEMI）住院并接受冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）的糖尿病患者的治疗结果。
本研究利用2024年7月24日从全球健康研究网络TriNetX获得的数据，评估接受心肌血运重建的糖尿病患者的主要心血管结局。使用国际疾病分类第十版诊断代码识别患有糖尿病和NSTEMI的患者。主要结局指标为5年全因死亡率。采用比例风险回归和倾向评分匹配法对关键患者的结局进行调整。
共纳入18115例患者，平均年龄62.2（标准差，8.98）岁，平均糖化血红蛋白A1c为7.66%（标准差，2.18%），其中8206例（45.3%）接受了CABG，9909例（54.7%）接受了PCI。在5年随访期间，所有队列记录了2275例（12.5%）死亡病例。倾向匹配产生了1:1的匹配，每组有7585例患者（CABG组与PCI组）；在5年的随访中，CABG与显著更低的全因死亡率相关（10.6%对17.9%；风险比，0.685；95%可信区间，0.618 - 0.759；P <.0001）。PCI队列中心肌梗死的发生率更高（48.6%对43.3%；P <.0001）。PCI患者在5年时再次进行冠状动脉血运重建的比例更高（14.5%对1.72%；P = 0.0229）。
在这项针对NSTEMI糖尿病患者的真实世界研究中，与PCI相比，CABG在5年时全因死亡率更低。
