CABG Outcomes in Diabetics With LV Dysfunction

What are the long-term results of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD), diabetes mellitus (DM), and left ventricular dysfunction (LVD)?

Methods:
The investigators used a propensity-matched study to compare outcomes for patients with CAD, DM, and LVD treated with PCI or CABG between 2004 and 2016. This registry study of patients cared for in Alberta, Canada of 110,000 included 2,387 patients. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as the composite of death, stroke, myocardial infarction (MI), and repeat revascularization. Secondary outcomes were the individual components of the primary outcome.

Results:
PCI as compared with CABG was associated with a higher risk of MACCE in both the ejection fraction (EF) 35-49% (p < 0.001) and EF <35% (p < 0.001) cohorts. Treatment with PCI was associated with an increased risk of death in both the EF 35-49% and the EF <35% cohorts. Stroke rate did not differ between PCI and CABG in either EF cohort. PCI was associated with an increased rate of MI in the EF <35% cohort and repeat revascularization occurred more frequently in those treated with PCI in both the EF 35-49% cohort and the EF <35% cohort.

Conclusions:
The authors concluded that at long-term follow-up, patients with CAD, DM, and LVD treated with CABG exhibited a significantly lower incidence of MACCE and better long-term survival over PCI, without a higher risk of stroke.

Perspective:
This study reports that in both moderate and severe LVD, PCI is associated with an increased risk of MACCE when compared to CABG. Furthermore, in patients with CAD, DM, and moderate or severe LVD, PCI is associated with poorer long-term survival compared to CABG. Also of note, there was no significant difference in incidence of stroke between PCI and CABG in both the moderate and severe LVD cohorts. Based on this and other available data, CABG should be considered first-line therapy for the treatment of multivessel CAD in patients with DM and LVD.