PCI and CABG Compared in Diabetic Patients From ACUITY Trial

June 1, 2015—Yanai Ben-Gal, MD, et al published findings from an evaluation of outcomes of diabetic patients with moderate and high-risk acute coronary syndrome and multivessel disease who were enrolled in the ACUITY (Acute Catheterization and Early Intervention Triage Strategy) trial and treated with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The study is available online ahead of print in Circulation: Cardiovascular Interventions.

The investigators concluded that in the large-scale ACUITY trial, those diabetic patients with acute coronary syndrome and multivessel disease who were treated with PCI rather than CABG had less bleeding and acute kidney injury, but showed a greater need for repeat revascularization procedures. They found that PCI and CABG had comparable rates of myocardial infarction, stroke, and death through 1-year follow-up.

The background of the study is that the preferred revascularization strategy for diabetic patients with acute coronary syndromes and multivessel coronary artery disease is uncertain.

As summarized in Circulation: Cardiovascular Interventions, the ACUITY trial enrolled 13,819 moderate- and high-risk acute coronary syndrome patients. Of these patients, there were 1,772 diabetic patients who had multivessel disease with left anterior descending artery involvement managed by PCI (n = 1,349) or CABG (n = 423). Propensity scoring was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 326 matched patients (163 managed by PCI and 163 managed by CABG). 

At 30 days, treatment with PCI compared with CABG was associated with lower rates of major bleeding (15.3% vs 55.6%; P < .0001), blood transfusions (9.2% vs 43.2%; P < .0001), and acute kidney injury (13.4% vs 33.6%; P < .0001), but more unplanned revascularization procedures (6.9% vs 1.9%; P = .03). At 1 year, PCI was associated with higher rates of repeat revascularization procedures (19.5% vs 5.2%; P = .0001), with nonsignificantly different rates of myocardial infarction, stroke, and death at either 30 days or 1 year, reported the investigators in Circulation: Cardiovascular Interventions.