Mortality After Multivessel Revascularization in Patients With Diabetes and Acute Coronary Syndromes
Main finding · All-cause mortalityResult — go to the resultHazard ratio 0.89 95% CI 0.80–0.98Authors' conclusion
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 preprocedure surgical consultation.
Study context
- Population
- Patients with DM and multivessel disease admitted for NSTEMI, Ontario, Canada, April 2009–March 2020; previous coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) in previous 90 days or shock excluded2,385 matched pairs
- Participants
- 4,649 vs 6,760
- Exposure
- CABG vs multivessel PCI
- CABGn = 4,649
- PCIn = 6,760reference
- Outcome
- All-cause mortality
- Follow-up
- Median 5.5 years
Methodological detailspropensity-score matched, population-based (Ontario, Canada), Patients with cardiac surgeon consultation then PCI classified as potentially ineligible for CABG
- Propensity-score matched
- Population-based (Ontario, Canada)
- Patients with cardiac surgeon consultation then PCI classified as potentially ineligible for CABG
Main finding
As reported in the abstract
5-year estimates
Hazard ratio
0.89
95% CI 0.80–0.98
P = 0.021
By group
CABGvs PCI
HR 0.89 (95% CI 0.80–0.98); P = 0.021
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality, by preprocedure surgical consultation in PCI patients (subgroup)CABGvs PCI | 0.97 (0.86–1.08) | ||
| All-cause mortality, by preprocedure surgical consultation in PCI patients (subgroup)CABGvs PCI | 0.72 (0.58–0.88) | P = 0.002 | |
| 0.512Hazard ratio (log scale) |
- All-cause mortality, by preprocedure surgical consultation in PCI patients (subgroup): PCI without surgical consultation (2,130 pairs); no significant difference
- All-cause mortality, by preprocedure surgical consultation in PCI patients (subgroup): PCI with surgical consultation, potentially ineligible for CABG (388 pairs)
Original publication
Mortality After Multivessel Revascularization in Patients With Diabetes and Acute Coronary Syndromes. JACC Adv. Published 18 September 2024. doi:10.
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