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Int J Cardiol. 2019 Dec 1;296:21-25. doi: 10.1016/j.ijcard.2019.07.038. Epub 2019 Jul 11.

Late clinical outcomes of unselected patients with diabetic mellitus and multi-vessel coronary artery disease.

Author information

1
Departments of Cardiology and Cardiothoracic Surgery, Liverpool Hospital, South Western Sydney Clinical School, the University of New South Wales, Sydney, NSW, Australia.
2
University of Sydney, Australia.
3
Departments of Cardiology and Cardiothoracic Surgery, Liverpool Hospital, South Western Sydney Clinical School, the University of New South Wales, Sydney, NSW, Australia; Departments of Cardiothoracic Surgery, Suez Canal University, Ismailia, Egypt.
4
Departments of Cardiology and Cardiothoracic Surgery, Liverpool Hospital, South Western Sydney Clinical School, the University of New South Wales, Sydney, NSW, Australia. Electronic address: j.french@unsw.edu.au.

Abstract

BACKGROUND:

The Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi-Vessel Disease (FREEDOM) clinical trial randomized only a proportion of screened patients with diabetes mellitus (DM) and multi-vessel disease (MVD).

METHODS AND RESULTS:

We determined late rates of death, non-fatal myocardial infarction (MI) and stroke in all 430 patients with DM who had MVD identified on angiographic screening for the FREEDOM Trial, which recruited from June 2006 -March 2010 at Liverpool Hospital, Sydney, Australia. Mortality at 6 years [median] was 23% among 192 FREEDOM-eligible patients and 26% among 238 FREEDOM-ineligible patients, of whom 139 [58%] had prior. CABG (mortality 31%). Overall, 196 (45%) had percutaneous coronary intervention (PCI), 127 (30%) underwent coronary artery bypass grafting (CABG) (who were 4 years younger; p = 0.003), and 107 (25%) had neither procedure of whom 80 were considered unsuitable for revascularization. Mortality was 26% post-PCI 16%, post-CABG and 33% among those who did not undergo revascularization (p = 0.01). On multivariable analyses, factors associated with late mortality were older age, hypertension and not undergoing CABG (all p < 0.05). Factors associated with late MI were presented with an acute coronary syndrome, whereas patients that underwent treatment with either PCI or CABG had less late MI (all p < 0.05).

CONCLUSION:

Among consecutive diabetic patients with MVD, at a median of 6-years CABG was associated with better survival and fewer non-fatal MI outcomes compared to PCI.

KEYWORDS:

Diabetes mellitus; Multi-vessel disease; Revascularization

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