Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With 3-Vessel Coronary Artery Disease and Diabetes.

Background: Coronary artery bypass grafting (CABG) has been associated with reduced mortality, myocardial infarction, and repeat revascularization compared with percutaneous coronary intervention (PCI) for patients with 3-vessel coronary artery disease (CAD) and diabetes. The majority of previous studies have been limited to follow-up of <10 years. Herein, we compared CABG and PCI in patients with 3-vessel coronary artery disease and diabetes with a maximum long-term follow-up of 14 years.

Methods: Patients with diabetes and 3-vessel coronary artery disease but without ST-segment-elevation myocardial infarction who underwent coronary angiography followed by CABG or PCI from 2009 to 2018 were included in this study. The primary outcome was mortality, and the secondary outcomes included myocardial infarction, stroke, or repeat revascularization. Outcomes were adjusted for age, sex, and clinical comorbidities.

Results: A total of 1210 patients underwent PCI (median follow-up, 9.1 years) while 477 underwent CABG (median follow-up, 8.1 years). Patients who underwent CABG were less likely to experience mortality (49.6% versus 57.6%, P=0.003, adjusted hazard ratio [aHR], 0.75 [95% CI, 0.61-0.91]), myocardial infarction (15.6% versus 28.1%, P<0.001, aHR, 0.45 [95% CI, 0.33-0.61]), or require repeat revascularization (7.7% versus 26.9%, P<0.001, aHR, 0.21 [95% CI, 0.14-0.30]) at longest follow-up. Risk of rehospitalization (82.6% versus 83.4%, P=0.656) and stroke (11.6% versus 12.2%, P=0.794) did not significantly differ between groups.

Conclusions: In this study, we describe one of the longest follow-up periods for patients with diabetes and 3-vessel coronary artery disease who underwent CABG or PCI and confirmed that the shorter-term benefits seen in randomized trials do translate into longer-term reductions in risk of death, myocardial infarction, or repeat revascularization.