Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Jan 11;20(1):16.
doi: 10.1186/s12933-020-01193-3.

Real-world outcomes of different treatment strategies in patients with diabetes and three-vessel coronary disease: a mean follow-up 6.3 years study from China

Xueyan Zhao  1 , Lianjun Xu  1 , Lin Jiang  1 , Jian Tian  1 , Yin Zhang  1 , Dong Wang  1 , Kai Sun  1 , Bo Xu  1 , Wei Zhao  1 , Rutai Hui  1 , Runlin Gao  1 , Lei Song  2 , Jinqing Yuan  3
Affiliations
Observational Study

Real-world outcomes of different treatment strategies in patients with diabetes and three-vessel coronary disease: a mean follow-up 6.3 years study from China

Xueyan Zhao et al. Cardiovasc Diabetol. .

Abstract

Background: Patients with diabetes and triple-vessel disease (TVD) are associated with a high risk of events. The choice of treatment strategies remains a subject of discussion. In the real-world, we aim to compare the outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) treatment strategies in patients with diabetes and TVD.

Methods: A total of 3117 consecutive patients with diabetes and TVD were enrolled. The primary endpoint was all-cause death and the secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, or stroke).

Results: During the mean follow-up of 6.3 ± 2.6 years, 573 (18.4%) deaths and 1094 (35.1%) MACCE occurred. Multivariate analysis showed that PCI (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.32-0.51) and CABG (HR 0.33, 95% CI 0.26-0.44) were associated with a lower risk of death compared with MT, with no difference between the PCI and CABG groups. When MACCE was the endpoint, PCI (HR 0.71, 95% CI 0.60-0.84) and CABG (HR 0.48, 95% CI 0.39-0.57) had a lower risk than MT. CABG was associated with a significantly lower risk of MACCE compared with PCI (HR 0.67, 95% CI 0.55-0.81), which was mainly attributed a lower risk in myocardial infarction, but a higher risk of stroke.

Conclusions: In this big real-world data and intermediate-term follow-up study, for patients with diabetes and TVD, PCI and CABG were associated with a lower risk of death and MACCE more than MT. The results suggest the importance of appropriate revascularization for diabetic patients with TVD. However, CABG was not associated with a lower risk of death, but with a lower risk of MACCE, compared with PCI. In the future, we perhaps should strengthen comprehensive treatment in addition to PCI or CABG.

Keywords: Diabetes; Prognosis; Treatment strategies; Triple-vessel coronary disease.

PubMed Disclaimer

Conflict of interest statement

All authors state that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient flow chart for the study cohort. Flowchart depicts patients enrolled. TVD  triple-vessel coronary disease; PCI percutaneous coronary intervention; CABG coronary artery bypass grafting
Fig. 2
Fig. 2
Kaplan–Meier survival curve analysis of death (a) (log-rank p < 0.0001) and MACCE (b) (log-rank p < 0.0001) according to different strategies Including PCI, CABG and MT treatment. PCI percutaneous coronary intervention, CABG coronary artery bypass grafting, MT  medical treatment, MACCE  major adverse cardiac and cerebrovascular events
Fig. 3
Fig. 3
Subgroup Analyses of Primary End Point. Hazard ratios and 95% confidence intervals are shown for the primary composite end point of all-cause death. P value represents interaction test between the variable and the relative treatment effect. PCI percutaneous coronary intervention, CABG coronary artery bypass grafting, SYNTAX Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Donahoe SM, Stewart GC, McCabe CH, Mohanavelu S, Murphy SA, Cannon CP, Antman EM. Diabetes and mortality following acute coronary syndromes. JAMA. 2007;298(7):765–75. - PubMed
    1. Rawshani A, Franzén S, Eliasson B, Svensson AM, Miftaraj M, McGuire DK, et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med. 2017;376(15):1407–18. - PubMed
    1. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367(25):2375–84. - PubMed
    1. Mohr FW, Morice MC, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381(9867):629–38. - PubMed
    1. Hakeem A, Garg N, Bhatti S, Rajpurohit N, Ahmed Z, Uretsky BF. Effectiveness of percutaneous coronary intervention with drug-eluting stents compared with bypass surgery in diabetics with multivessel coronary disease: comprehensive systematic review and meta-analysis of randomized clinical data. Journal of the American Heart Association. 2013;2(4):e000354. - PMC - PubMed

Publication types

MeSH terms

Substances