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

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.

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

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