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Randomized Controlled Trial
. 2023 Oct 9;16(19):2412-2422.
doi: 10.1016/j.jcin.2023.07.028.

Everolimus-Eluting Stents or Bypass Surgery for Multivessel Disease in Diabetics: The BEST Extended Follow-Up Study

Hoyun Kim  1 , Do-Yoon Kang  1 , Jung-Min Ahn  2 , Jinho Lee  1 , Yeonwoo Choi  1 , Seung Ho Hur  3 , Hun-Jun Park  4 , Damras Tresukosol  5 , Woong Chol Kang  6 , Hyuck Moon Kwon  7 , Seung-Woon Rha  8 , Do-Sun Lim  9 , Myung-Ho Jeong  10 , Bong-Ki Lee  11 , He Huang  12 , Young-Hyo Lim  13 , Jang Ho Bae  14 , Byung Ok Kim  15 , Tiong Kiam Ong  16 , Sung Gyun Ahn  17 , Cheol-Hyun Chung  1 , Duk-Woo Park  1 , Seung-Jung Park  1 ; BEST Extended Follow-Up Study Investigators
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Free article
Randomized Controlled Trial

Everolimus-Eluting Stents or Bypass Surgery for Multivessel Disease in Diabetics: The BEST Extended Follow-Up Study

Hoyun Kim et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Diabetes mellitus is associated with more complex coronary artery diseases. Coronary artery bypass grafting (CABG) is a preferred revascularization strategy over percutaneous coronary intervention (PCI) in diabetics with multivessel coronary artery disease (MVD).

Objectives: This study sought to examine the different prognostic effects of revascularization strategies according to the diabetes status from the randomized BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease) trial.

Methods: Patients (n = 880) with MVD were randomly assigned to undergo PCI with an everolimus-eluting stent vs CABG stratified by diabetics (n = 363) and nondiabetics (n = 517). The primary endpoint was the composite of death, myocardial infarction, or target vessel revascularization during a median follow-up of 11.8 years (IQR: 10.6-12.5 years).

Results: In diabetics, the primary endpoint rate was significantly higher in the PCI group than in the CABG group (43% and 32%; HR: 1.53; 95% CI: 1.12-2.08; P = 0.008). However, in nondiabetics, no significant difference was found between the groups (PCI group, 29%; CABG group, 29%; HR: 0.97; 95% CI: 0.67-1.39; P = 0.86; Pinteraction= 0.009). Irrespective of the presence of diabetes, no significant between-group differences were found in the rate of a safety composite of death, myocardial infarction, or stroke and mortality rate. However, the rate of any repeat revascularization was significantly higher in the PCI group than in the CABG group.

Conclusions: In diabetics with MVD, CABG was associated with better clinical outcomes than PCI. However, the mortality rate was similar between PCI and CABG irrespective of diabetes status during an extended follow-up. (Ten-Year Outcomes of Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST Extended], NCT05125367; Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST], NCT00997828).

Keywords: bypass surgery; coronary intervention; diabetes; multivessel disease; stent(s).

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Conflict of interest statement

Funding Support and Author Disclosures This research was supported by a grant from the Korea Health Technology R and D Project through the Korea Health Industry Development Institute funded by the Ministry of Health and Welfare, Republic of Korea (grant number HC19C0022). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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