CABG bests PCI in patients with T2D, stable IHD, and CKD

  • J Am Coll Cardiol

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In patients with type 2 diabetes (T2D), stable ischemic heart disease (SIHD), and chronic kidney disease (CKD), coronary artery bypass grafting (CABG) may lower risks for major adverse cardiovascular or cerebrovascular events (MACCE) and subsequent revascularizations compared with percutaneous coronary intervention (PCI).

Why this matters

  • The optimal coronary revascularization strategy in patients with SIHD, T2D, and CKD is unclear.

Study design

  • Pooled analysis from 3 large randomized trials of 4953 SIHD patients with T2D, including 21.4% with CKD.
  • Primary endpoint was composite MACCE, including adjusted all-cause death, myocardial infarction, or stroke.
  • Funding: Gilead Sciences.

Key results

  • 5-year mortality was 22.3% and 9.8% in those with and without CKD, respectively (P=.0001).
  • Vs no CKD, those with CKD had greater risks for (fully adjusted HR [aHR]):
    • MACCE: 1.48 (P=.0001) and
    • Death: 1.69 (P=.0001), but not for
    • Subsequent revascularization: 1.05 (P=.55).
  • In patients with CKD, significantly fewer revascularizations with CABG+optimal medical therapy (OMT) vs PCI+OMT:
    • aHR, 0.17 (P=.0004).
  • With moderate-severe CKD, trend toward lower MACCE with CABG+OMT vs PCI+OMT:
    • aHR, 0.68 (P=.17).

Limitations

  • Newer technologies, surgical advances, and diabetes medications unavailable at time of studies.  
  • Limited ability to detect differences among CKD subgroups, or by vascularization status.
  • Results restricted to study populations.

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