PCI vs. CABG in Left Main Disease and Diabetes Status

18 Mar 2024 • What are the outcomes in patients with left main disease with and without diabetes undergoing percutaneous coronary intervention versus coronary artery bypass grafting?

  • A comprehensive analysis of patients undergoing revascularization for left main disease reports that patients with diabetes had higher 5-year rates of all-cause death, spontaneous MI, repeat revascularization, and stroke.
  • Of note, the risk of cardiovascular death tended to be higher with PCI in patients with diabetes and high SYNTAX scores.
  • Furthermore, PCI resulted in lower rates of early stroke compared with CABG but higher rates of spontaneous MI and repeat revascularization, with greater absolute risk excesses in later follow-up, particularly among patients with diabetes.

Overall, these data support a Class IA recommendation in the 2021 ACC/AHA revascularization guidelines that state, for patients with diabetes and multivessel coronary artery disease with the involvement of the left anterior descending artery, CABG (with a left anterior mammary artery to the LAD) is recommended in preference to PCI to reduce mortality and repeat revascularizations.

Source: ACC | Read full story

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