Outcomes after coronary artery bypass grafting and percutaneous coronary intervention in diabetic and non-diabetic patients

Abstract

<p><strong>Aims</strong><br></p><p>To assess the prognosis of patients with coronary heart disease (CHD) after first myocardial revascularisation procedure in real world practice and to compare the differences in outcomes of coronary artery by-pass grafting (CABG) and percutaneous coronary intervention (PCI) among diabetic and non-diabetic patients.<br></p><p><strong>Methods and results</strong><br></p><p><strong></strong>A database was compiled from the national hospital discharge register to collect data on all cardiac revascularisations performed in Finland in 2000-2015. The outcomes (all-cause deaths, cardiovascular (CV) deaths, major CV events and need for repeat revascularisation) after the first revascularisation were identified from the national registers at 28-day, 1-year and 3-year time points.<br></p><p>A total of 139,242 first-time revascularisations (89,493 PCI and 49,749 CABG) were performed during the study period. Of all the revascularized patients, 24% had diabetes, and 76% were non-diabetic patients. At day 28 the risk of fatal outcomes was lower after PCI than after CABG among non-diabetic patients, whereas no difference was seen among diabetic patients. In long-term follow-up the situation was reversed with PCI showing higher risk compared with CABG for most of the outcomes. In particular, at three-year follow-up the risk of all-cause deaths was elevated among diabetic patients (HR 1.30 (95% CI 1.22-1.38) comparing PCI with CABG) more than among non-diabetic patients (HR 1.09 (1.04-1.15)). The same was true for CV deaths (HR 1.29 (1.20-1.38) among diabetic patients, and HR 1.03 (0.98-1.08) among non-diabetic patients).<br></p><p><strong>Conclusion</strong></p><p>Although PCI was associated with better 28-day prognosis, CABG seemed to produce better long-term prognosis especially among diabetic patients.</p>