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

¹ Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
² Lille Heart Institute, University of Lille, Lille, France
³ Clinical Epidemiology Unit, Thoraxcenter Cardiology, Erasmus MC, Rotterdam, the Netherlands
⁴ Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany
⁵ Department of Cardiology, Centre Hospitalier Universitaire du Sart Tilman, Liege, Belgium
⁶ Cardiovascular Center, Aalst, Belgium

Address correspondence and reprint requests to Eric Boersma, PhD, Clinical Epidemiology Unit, Thoraxcenter Cardiology, Rm. Ba-563, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands. E-mail: h.boersma{at}erasmusmc.nl

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.

Abbreviations: BARI, Bypass Angioplasty Revascularization Investigation • CABG, coronary artery bypass surgery • CAD, coronary artery disease • CVA, cerebrovascular accident • DES, drug-eluting stent • EHS-CR, Euro Heart Survey on Coronary Revascularization • LAD, left anterior descending artery • MI, myocardial infarction • NYHA, New York Heart Association • PCI, percutaneous coronary intervention

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