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Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).
Am J Cardiol 2015; 115(8):1063-72AJ

Abstract

We investigated the impact of diabetes mellitus on long-term outcomes of percutaneous coronary intervention (PCI) in the drug-eluting stent era versus coronary artery bypass grafting (CABG) in a real-world population with advanced coronary disease. We identified 3,982 patients with 3-vessel and/or left main disease of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (patients without diabetes: n = 1,984 [PCI: n = 1,123 and CABG: n = 861], and patients with diabetes: n = 1,998 [PCI: n = 1,065 and CABG: n = 933]). Cumulative 5-year incidence of all-cause death after PCI was significantly higher than after CABG both in patients without and with diabetes (19.8% vs 16.2%, p = 0.01, and 22.9% vs 19.0%, p = 0.046, respectively). After adjusting confounders, the excess mortality risk of PCI relative to CABG was no longer significant (hazard ratio [HR] 1.16; 95% confidence interval [CI] 0.88 to 1.54; p = 0.29) in patients without diabetes, whereas it remained significant (HR 1.31; 95% CI 1.01 to 1.70; p = 0.04) in patients with diabetes. The excess adjusted risks of PCI relative to CABG for cardiac death, myocardial infarction (MI), and any coronary revascularization were significant in both patients without (HR 1.59, 95% CI 1.01 to 2.51, p = 0.047; HR 2.16, 95% CI 1.20 to 3.87, p = 0.01; and HR 3.30, 95% CI 2.55 to 4.25, p <0.001, respectively) and with diabetes (HR 1.45, 95% CI 1.00 to 2.51, p = 0.047; HR 2.31, 95% CI 1.31 to 4.08, p = 0.004; and HR 3.70, 95% CI 2.91 to 4.69, p <0.001, respectively). There was no interaction between diabetic status and the effect of PCI relative to CABG for all-cause death, cardiac death, MI, and any revascularization. In conclusion, in both patients without and with diabetes with 3-vessel and/or left main disease, CABG compared with PCI was associated with better 5-year outcomes in terms of cardiac death, MI, and any coronary revascularization. There was no difference in the direction and magnitude of treatment effect of CABG relative to PCI regardless of diabetic status.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Cardiovascular Surgery, Nara Hospital Kinki University School of Medicine, Ikoma, Japan. Electronic address: marui@kuhp.kyoto-u.ac.jp.Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.Department of Cardiovascular Surgery, Nara Hospital Kinki University School of Medicine, Ikoma, Japan.Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan.Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25733384

Citation

Marui, Akira, et al. "Five-year Outcomes of Percutaneous Versus Surgical Coronary Revascularization in Patients With Diabetes Mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)." The American Journal of Cardiology, vol. 115, no. 8, 2015, pp. 1063-72.
Marui A, Kimura T, Nishiwaki N, et al. Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol. 2015;115(8):1063-72.
Marui, A., Kimura, T., Nishiwaki, N., Mitsudo, K., Komiya, T., Hanyu, M., ... Sakata, R. (2015). Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). The American Journal of Cardiology, 115(8), pp. 1063-72. doi:10.1016/j.amjcard.2015.01.544.
Marui A, et al. Five-year Outcomes of Percutaneous Versus Surgical Coronary Revascularization in Patients With Diabetes Mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol. 2015 Apr 15;115(8):1063-72. PubMed PMID: 25733384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). AU - Marui,Akira, AU - Kimura,Takeshi, AU - Nishiwaki,Noboru, AU - Mitsudo,Kazuaki, AU - Komiya,Tatsuhiko, AU - Hanyu,Michiya, AU - Shiomi,Hiroki, AU - Tanaka,Shiro, AU - Sakata,Ryuzo, AU - ,, Y1 - 2015/02/02/ PY - 2014/12/05/received PY - 2015/01/13/revised PY - 2015/01/13/accepted PY - 2015/3/4/entrez PY - 2015/3/4/pubmed PY - 2015/6/3/medline SP - 1063 EP - 72 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 115 IS - 8 N2 - We investigated the impact of diabetes mellitus on long-term outcomes of percutaneous coronary intervention (PCI) in the drug-eluting stent era versus coronary artery bypass grafting (CABG) in a real-world population with advanced coronary disease. We identified 3,982 patients with 3-vessel and/or left main disease of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (patients without diabetes: n = 1,984 [PCI: n = 1,123 and CABG: n = 861], and patients with diabetes: n = 1,998 [PCI: n = 1,065 and CABG: n = 933]). Cumulative 5-year incidence of all-cause death after PCI was significantly higher than after CABG both in patients without and with diabetes (19.8% vs 16.2%, p = 0.01, and 22.9% vs 19.0%, p = 0.046, respectively). After adjusting confounders, the excess mortality risk of PCI relative to CABG was no longer significant (hazard ratio [HR] 1.16; 95% confidence interval [CI] 0.88 to 1.54; p = 0.29) in patients without diabetes, whereas it remained significant (HR 1.31; 95% CI 1.01 to 1.70; p = 0.04) in patients with diabetes. The excess adjusted risks of PCI relative to CABG for cardiac death, myocardial infarction (MI), and any coronary revascularization were significant in both patients without (HR 1.59, 95% CI 1.01 to 2.51, p = 0.047; HR 2.16, 95% CI 1.20 to 3.87, p = 0.01; and HR 3.30, 95% CI 2.55 to 4.25, p <0.001, respectively) and with diabetes (HR 1.45, 95% CI 1.00 to 2.51, p = 0.047; HR 2.31, 95% CI 1.31 to 4.08, p = 0.004; and HR 3.70, 95% CI 2.91 to 4.69, p <0.001, respectively). There was no interaction between diabetic status and the effect of PCI relative to CABG for all-cause death, cardiac death, MI, and any revascularization. In conclusion, in both patients without and with diabetes with 3-vessel and/or left main disease, CABG compared with PCI was associated with better 5-year outcomes in terms of cardiac death, MI, and any coronary revascularization. There was no difference in the direction and magnitude of treatment effect of CABG relative to PCI regardless of diabetic status. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/25733384/Five_year_outcomes_of_percutaneous_versus_surgical_coronary_revascularization_in_patients_with_diabetes_mellitus__from_the_CREDO_Kyoto_PCI/CABG_Registry_Cohort_2__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(15)00639-6 DB - PRIME DP - Unbound Medicine ER -