Abstract:

Background: The optimal revascularization strategy in patients with diabetes and multivessel disease in the setting of a non-ST elevation myocardial infarction (NSTEMI) is unknown.
Objectives: Compare all-cause mortality between coronary artery bypass grafting (CABG) and multivessel percutaneous coronary intervention (PCI) among patients with diabetes and NSTEMI.

Methods: All patients with diabetes and multivessel disease admitted for NSTEMI in Ontario, Canada between April 2009 and March 2020, were included. Those with previous CABG, PCI in the previous 90 days, or shock were excluded. The primary outcome was all-cause mortality. Propensity score matching was used to account for confounding. Patients who had a cardiac surgeon consultation and then received PCI were classified as being potentially ineligible for CABG.

Results: The cohort included 4,649 CABG and 6,760 PCI patients (mean age: 67.8±11.5years; 70.4% males), resulting in 2,385 matched pairs. CABG was associated with reduced all-cause mortality compared to PCI over a median follow-up of 5.5years (5-year estimates: 23.4% vs 26.5%; HR: 0.89, 95%CI: 0.80-0.98, p=0.021). However, no significant differences in mortality were observed between CABG and PCI patients without a surgical consultation (2,130 pairs; HR: 0.97; 95%CI: 0.86-1.08), while CABG was associated with reduced mortality when compared against PCI patients who had received a surgical consultation (388 pairs; HR: 0.72; 95%CI: 0.58-0.88; p=0.002).

Conclusions: While CABG was associated with reduced all-cause mortality compared to multivessel PCI in patients with diabetes and NSTEMI, CABG benefit was seen only against PCI patients potentially ineligible for CABG after receiving a pre-procedure surgical consultation.

JACC: Advances Editor-in-Chief 

Candice K. Silversides, MD, FACC

JACC: Advances CME Editor

Kenneth A. Ellenbogen, MD

Authors

Valerian Fernandes, MD

Important Dates

Date of Release: September 18, 2024 

Term of Approval/Date of CME/MOC Expiration: September 17, 2025