Comparing Coronary Artery Bypass Grafting with Drug-eluting Stenting in Patients with Diabetes Mellitus and Multivessel Coronary Artery Disease

Igor Sigaev, Milena Keren, Rustam Yarbekov, Artak Kazaryan, Maxim Starostin, Beka Morchadze , Yulia Tereshina, Leo Bockeria

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–C

Abstract

OBJECTIVES:

The aim of our study was to assess the safety of coronary artery bypass grafting (CABG) compared with drug-eluting stent implantation in patients with diabetes mellitus (DM) and multivessel coronary artery disease.

METHODS:

The study included 379 diabetic patients (DM type 2) with multivessel lesions of the coronary arteries after CABG [n = 282] or PCI with DES [n = 97].  Primary end point (major adverse cardiac and cerebral events (MACCE)) was a composite of death, non-fatal myocardial infarction, non-fatal stroke and repeated myocardial revascularization at a mean follow-up of 5 years.

RESULTS:

The mean follow-up period was 4,8 years. There were no significant differences in the mortality rate after CABG and PCI with DES (75.5% and 79.4%, p = 0.48). Freedom from myocardial infarction in the CABG group was significantly higher, compared with the PCI with DES (84.1% and 77%, p = 0.046). Five-year freedom from repeated revascularization, was, also, significantly higher in the group after CABG, compared with PCI (77.4% and 69.4%, respectively (p = 0.048)). Cumulative freedom from MACCE in the CABG group was 60.3%, and in the PCI group - 50.8% (p = 0.005). However, patients in the CABG group had a higher risk for stroke events, compared with the PCI with DES (78.7% and 88.9%, respectively, p = 0.048).   

 CONCLUSIONS:

 The five-year survival between patients with diabetes after CABG and PCI with DES is comparable. However, a decrease of rate of myocardial infarction, repeated revascularization and MACCE after CABG, compared with PCI, makes CABG more preferre revascularization method for diabetic patients with multivessel CAD.