Among patients with left main disease who undergo coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), presenting with diabetes is associated with a higher five-year risk of death or adverse cardiovascular events, according to new data published in Circulation.[1]
“Left main coronary artery disease and diabetes are associated with substantial cardiovascular morbidity and mortality,” wrote first author Prakriti Gaba, MD, a cardiology fellow with Brigham and Women’s Hospital and Harvard Medical School, and colleagues. “Yet, long-term outcomes for patients with left main disease and diabetes undergoing PCI compared with CABG remain unclear … previous trials comparing PCI and CABG in patients with multivessel disease without left main involvement have suggested that diabetes might be a modulating factor for clinical outcomes, as evidenced by a lower five-year mortality rate in patients with diabetes after CABG but similar five-year mortality rate after PCI and CABG in patients without diabetes.”
Gaba et al. performed a pooled analysis of more than 4,300 patients with left main disease who were treated with either CABG or PCI. One in four patients presented with diabetes. All-cause mortality after five years was the study’s primary endpoint, though researchers also explored data on cardiovascular death, noncardiovascular death, spontaneous myocardial infarctions (MI) and other adverse events.
Overall, patients with diabetes were linked to higher five-year rates of all-cause mortality (14.7% vs. 9.3%), spontaneous MI (6.7% vs. 3.7%) and repeat revascularization (18.5% vs. 13.2%).
“Although it is already established that diabetes, especially insulin-treated diabetes, is associated with higher rates of adverse cardiovascular events, these findings emphasize that the presence of left main coronary disease and diabetes presents a distinctly high-risk scenario requiring careful attention to medical optimization, cardiovascular risk reduction and appropriate revascularization,” the authors wrote.
The study’s authors also compared outcomes after CABG and PCI. While they had comparable all-cause mortality rates, each approach was also associated with its own clinical benefit. CABG patients had lower rates of spontaneous MI and repeat revascularization, for example, while PCI patients faced a lower one-year risk of stroke.
Researchers noted that these findings highlight the importance of providing personalized care to heart patients with left main disease, whether or not they present with diabetes.
“Pooled individual patient-level data from four major randomized clinical trials of left main disease now provide further clarity on the tradeoffs between the two approaches,” they concluded. “These data can be used by a collaborative heart team when contemplating the revascularization approach and engaging in shared decision-making with each patient.”
Click here to read the full study in Circulation, a journal from the American Heart Association.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.