Long-term prognosis of percutaneous coronary intervention and coronary bypass surgery in patients with diabetes mellitus.

2005 Fiscal Year Final Research Report Summary

• Project/Area Number: 16615002
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: 臨床疫学
• Research Institution: KYOTO UNIVERSITY
• Principal Investigator: KIMURA Takeshi Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, Associate Professor, 医学研究科, 助教授 (80359786)
• Co-Investigator(Kenkyū-buntansha): FURUKAWA Yutaka Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, Associate Professor, 医学研究科, 助手 (60359833)
• Project Period (FY): 2004 – 2005
• Keywords: Coronary artery disease / Diabetes mellitus / Percutaneous coronary intervention / Coronary bypass surgery / Prognosis

Research Abstract

We have investigated the impact of mode of coronary revascularization on the prognosis of diabetic patients with multi-vessels coronary disease after coronary revascularization therapy. From 30 institutions, 8,947 patients undergoing first percutaneous coronary intervention (PCI) or coronary bypass surgery (CABG) without concomitant surgeries were registered. The study subjects consists of 1,741 diabetic patients (PCI group;1129 pts, CABG group;612pts) who have at least two lesions located in different vessels. The left main coronary artery disease and patients【greater than or equal】75years old were excluded. Baseline clinical characteristics were as follows (PCI vs CABG) : renal dysfunction (serum creatinin>1.5mg/dl)(12.3% vs 16.1%, p=0.03), triple vessel disease (40.7% vs 84.5%, p<0.0001), reduced left ventricular function (LVEF<35%)(5.2% vs 7.1%, p=NS). The follow up period was 982±494 days. There was no significant difference in the survival rate free from any-cause death, cerebrovascular accident (CVA) and MACE (defined as death, MI or CVA) between PCI group and CABG group (PCI vs CABG at 3 years ; death;91.4% vs 93.2%, CVA;96.2% vs 93.1%, MACE;85.2% vs 85.2%). The rate of free from MI and any revascularization were higher in CABG group than PCI group (PCI vs CABG at 3years;95.0% vs 97.6%, p=0.03:43.6% vs 90.8%, p<0.0001). By multivariate analysis, the independent predictors of all-cause death were as follows ; R.R.(95% C.I.) ; renal dysfunction (serum creatinin>1.5mg/dl):4.38(2.71-7.15), p<0.0001,history of heart failure:1.57(1.02-2.38), p=0.01,valvular heart disease:2.46(1.19-4.59), p<0.02. Mode of revascularization was not an independent predictor ; CABG:0.89(0.72-1.09), p=NS.
Thus, in multi-vessel diabetic patients<75 years old, PCI yielded an equivalent long-term survival outcome compared with CABG. PCI was associated with higher incidence of repeat revascularization.