NCDR ACTION Registry–GWTG Evaluated 6-Year Revascularization Trends

May 13, 2016—A study evaluated revascularization trends in patients with diabetes mellitus and multivessel coronary artery disease (CAD) presenting with non-ST elevation myocardial infarction (STEMI) using data from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry–Get with the Guidelines (NCDR ACTION Registry–GWTG).

Ambarish Pandey, MD, et al published the findings online ahead of print in Circulation: Cardiovascular Quality and Outcomes.

According to the investigators, current guidelines recommend surgical revascularization by coronary artery bypass graft (CABG) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel CAD. They noted that few data are available describing revascularization patterns among these patients in the setting of non-STEMI.

From the ACTION Registry–GWTG, the investigators compared the in-hospital use of different revascularization strategies (PCI vs CABG vs no revascularization) in diabetes mellitus patients with non-STEMI who had angiography that showed multivessel CAD between July 2008 and December 2014.

Logistic multivariable regression analyses identified factors associated with the use of CABG versus PCI. A total of 29,769 patients from 539 hospitals were included in the study, of which 10,852 (36.4%) were treated with CABG, 13,760 (46.2%) were treated with PCI, and 5,157 (17.3%) were treated without revascularization.

The investigators reported that the overall use of revascularization increased during the study period with an increase in the proportion undergoing PCI (45% to 48.9%; P-trend = .0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; P-trend = .88). There was significant variability between participating hospitals in the use of PCI and CABG (range, 22%–100% and 0%–78%, respectively; P < .0001 for both).

Patient-level, but not hospital-level, characteristics were statistically associated with the use of PCI versus CABG, including anatomic severity of the disease, early treatment of adenosine diphosphate receptor antagonists at presentation, being of older age, being of female sex, and having a history of heart failure.

The study showed that among patients with diabetes mellitus and multivessel CAD presenting with non-STEMI, only one-third undergo CABG during the index admission; furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years, concluded the investigators in Circulation: Cardiovascular Quality and Outcomes.