PCI reasonable for some with DM and left main disease

  • Milojevic M & al.
  • J Am Coll Cardiol
  • 9 Apr 2019

  • International Clinical Digest
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Takeaway

  • Among patients with left main (LM) coronary artery disease (CAD) and low or intermediate CAD complexity, those with diabetes mellitus (DM) had similar 3-year outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES) vs coronary artery bypass grafting (CABG).
  • Results are hypothesis-generating.
  • Editorial  discusses how to choose revascularization technique in LMCAD patients.

Why this matters

  • CABG is preferred revascularization technique for diabetic patients with complex CAD, but PCI and CABG techniques have recently improved. 

Key results

  • With DM vs without:
    • Primary outcome: 20.0% vs 12.9% (P<.001>
    • All-cause death: 10.9% vs 5.3% (P<.001>
  • Primary outcome after PCI vs CABG among:
    • Diabetic patients: 20.7% vs 19.3% (P=.87).
    • Nondiabetic patients: 12.9% vs 12.9% (P=.89).
  • All-cause death after PCI vs CABG among diabetic patients: 13.6% vs 8.0%  (P=.046).
  • No interaction of DM with CABG and PCI.

Study design

  • Prespecified subgroup analysis of EXCEL (N=1905).
  • Patients with LMCAD and low or intermediate SYNTAX score randomly assigned to CABG vs PCI with second-generation EES.
  • Authors analyzed outcome among patients with DM vs without (n=554 and 1350, respectively).
  • Outcome: 3-year composite of all-cause death, stroke, myocardial infarction.
  • Funding: Abbott Vascular.

Limitations

  • Underpowered to assess primary outcome with PCI vs CABG in subgroup with diabetes. 

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