P1388Late clinical outcomes of unselected patients with diabetic mellitus and multi-vessel coronary artery disease

Abstract

Background: In randomized clinical trials, patients with diabetes mellitus (DM) and multi‐vessel disease (MVD) have better late clinical outcomes after coronary artery bypass grafting (CABG) than percutaneous coronary intervention (PCI), though these trials recruit only a small proportion of potentially eligible patients. Thus, we assessed late event rates among unselected diabetic patients with MVD. Methods and results: Clinical events including death, non‐fatal myocardial infarction and stroke were determined among 428 patients with DM and MVD during screening for the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi‐Vessel Disease (FREEDOM) trial. From 2006 to 2010 at Liverpool Hospital Sydney, these patients underwent PCI (n=191), CABG (n=124) or neither (n=113). Patients who underwent CABG, were 4 years younger than other patients, and had much lower rates of prior CABG (both p{\textless}0.001). Mortality (unadjusted) at median 6 years follow up was 15.6\% post‐CABG, 26.4\% post‐PCI and 36.0\% among those managed without revascularization. On multivariable analyses, factors associated with late mortality were older age, hypertension and no treatment with CABG (all p{\textless}0.025). Factors associated with late myocardial infarction (MI) were presentation with an acute coronary syndrome, left main stenosis, whereas patients with prior CABG and treatment with either PCI or CABG had less late MI (all p{\textless}0.05). Conclusion: We found that at median 6‐year follow‐up, among diabetic patients with MVD, CABG was associated with better survival and non‐fatal MI outcomes whereas PCI had less non‐fatal MIs. (Figure Presented).