Journal Article

Diabetes Does Not Influence Treatment Decisions Regarding Revascularization in Patients With Stable Coronary Artery Disease

Breeman, Arno, Ottervanger, Jan Paul, Wijns, William, Legrand, Victor, Sechtem, Udo, Lenzen, Mattie, Boersma, Eric, Boer, Menko-Jan de, Hoeks, Sanne, Bertrand, Michel E

2006

Overview

OBJECTIVE:--To evaluate whether in stable angina preference for coronary revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) is influenced by diabetes status and whether this has prognostic implications. RESEARCH DESIGN AND METHODS--A total of 2,928 consecutive patients with stable angina who were enrolled in the prospective Euro Heart Survey on Coronary Revascularization were studied. Multivariable analyses were applied to evaluate the relation between diabetes, treatment decision, and 1-year outcome. RESULTS:--Diabetes was documented in 587 patients (20%) who had more extensive coronary disease. Revascularization was intended in 74% of patients with diabetes and in 77% of those without diabetes. In patients selected for revascularization, CABG was intended in 35% of diabetic and in 33% of nondiabetic patients. Multivariable analyses did not change these findings, but in some subgroups diabetes influenced treatment decisions. For example, diabetic subjects with mild heart failure had more often intended revascularization (91%) than those without diabetes (67%, P < 0.001). Treatment decisions in patients with more extensive (left main, multivessel, or proximal left anterior descending artery) disease were not influenced by diabetes status. Diabetes was not associated with an increased incidence of all-cause death, nonfatal cerebrovascular accident, or nonfatal myocardial infarction at 1 year, regardless of preferred treatment. The incidence of the combined end points was 7.3% in diabetic and 6.8% in nondiabetic patients (adjusted hazard ratio 1.0 [95% CI 0.7-1.4]). CONCLUSIONS:--In stable angina, treatment decisions regarding revascularization or the choice for CABG or PCI were not influenced by the presence of diabetes. Diabetes was not associated with a poor prognosis.

• Publisher: American Diabetes Association
• Subject: Aged / Biological and medical sciences / Cardiology. Vascular system / Care and treatment / cerebrovascular disorders / complications / Coronary Artery Bypass / Coronary Artery Bypass - methods / Coronary Artery Disease / Coronary Artery Disease - complications / Coronary Artery Disease - diagnosis / Coronary Artery Disease - surgery / Coronary heart disease / coronary vessels / Diabetes / Diabetes Complications / Diabetes Complications - complications / Diabetes Mellitus / Diabetes Mellitus - pathology / Diabetes. Impaired glucose tolerance / diagnosis / Endocrine pancreas. Apud cells (diseases) / Endocrinologie, métabolisme & nutrition / Endocrinology, metabolism & nutrition / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Europe / Female / Follow-Up Studies / Health Surveys / Heart / Human health sciences / Humans / Male / Medical sciences / Medical treatment / methods / Middle Aged / mortality / Multivariate Analysis / Myocardial Revascularization / Myocardial Revascularization - methods / pathology / Patient outcomes / Prognosis / Prospective Studies / Risk factors / Sciences de la santé humaine / Stents / Surgery / Treatment Outcome / Veins & arteries