PCI With EES Compares Favorably to CABG in Patients With Diabetes and Multivessel Disease

July 9, 2015—Findings from a comparison of percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES) versus coronary artery bypass graft surgery (CABG) for patients with diabetes mellitus and multivessel disease were published by Sripal Bangalore, MD, et al and are available online ahead of print in Circulation: Cardiovascular Interventions.

The investigators noted in the study background that there are few data comparing CABG against these newer-generation stents.

As summarized in Circulation: Cardiovascular Interventions, patients in the New York State registries who had diabetes mellitus and underwent isolated CABG or PCI with EES for multivessel disease were included in this evaluation. 

The investigators used propensity score matching to assemble a cohort with similar baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. Short-term (within 30 days) and long-term outcomes were evaluated. 

Of the 16,089 patients with diabetes and multivessel disease, the comparison included 8,096 patients with similar propensity scores. 

In the short-term, EES were associated with a lower risk of death and stroke but higher risk of MI. In the long-term, EES were associated with a similar risk of death (425 [10.5%] vs 414 [10.23%] events), a lower risk of stroke (118 [2.92%] vs 157 [3.88%] events), but a higher risk of MI (260 [6.42%] vs 166 [4.10%] events) and repeat revascularization (889 [21.96%] vs 421 [10.4%] events). The higher risk of MI was not seen in the subgroup of EES patients who underwent complete revascularization, advised the investigators.

From these data, the investigators concluded that in patients with diabetes and multivessel disease, EES were associated with a lower upfront risk of death and stroke when compared with CABG. In the long-term, EES were associated with similar risk of death, a higher risk of MI in those patients with incomplete revascularization and repeat revascularization, and a lower risk of stroke, reported the investigators in Circulation: Cardiovascular Interventions.