SPC365

CABG vs PCI for diabetic patients with non-ST elevation ACS: one-year outcomes

Session: Posters (Sessão 2 - Écran 6) - DAC e Cuidados Intensivos 3 - SCAsST
Speaker: Carolina Saleiro

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Carolina Saleiro; Joana m Ribeiro; Diana de Campos; João Lopes; Ana Rita m Gomes; José p Sousa; Alexandrina Siserman; Carolina Lourenço; Lino Gonçalves; em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Background:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> The role of coronary artery bypass-graft (CABG) versus percutaneous coronary intervention (PCI) in diabetes mellitus (DM) patients is well established for patients with multivessel chronic coronary artery disease. In the context of non-ST elevation acute coronary syndrome (NST-ACS), few data are available comparing both strategies. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Aim:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> To assess the prognostic impact of CABG vs PCI in DM patients presenting with NST-ACS.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> <span style="color:#201f1e">32027 </span>ACS patients included in the Portuguese Registry of Acute Coronary Syndromes (2010-2021) were retrospectively assessed. Clinical, laboratorial, and echocardiographic data were evaluated. Diabetic patients presenting with NST-ACS were screened (n=<span style="color:#201f1e">6 368). After excluding patients with previous CABG, significant valvular disease, single vessel disease, medically treated only, and those without long-term follow-up, 761 patients were included. Two groups were created based on the revascularization strategy: Group A &ndash; CABG (n=248) and group B &ndash; PCI (n=</span>513<span style="color:#201f1e">). The primary endpoint was a composite outcome of one-year mortality or hospitalization for cardiovascular (CV) causes; one-year mortality was assessed separately as a secondary endpoint. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#201f1e">Results: </span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#201f1e">The groups were similar regarding gender, CV risk factors, heart failure (HF) diagnosis or previous MI, and left ventricular (LV) systolic function, but patients treated with CABG were younger (67&plusmn;9 <em>vs</em> 69&plusmn;11 years old, P&lt;0.05). There were no differences in intra-hospital complications. During the 1-year follow-up, the composite endpoint of death or re-hospitalization occurred in 162 patients and CV death occurred in 45 patients. Kaplan-Meyer curves showed that patients in the CABG group had a lower survival free of events (ie. CV hospitalization or death) - 69,9% vs 81,6%, Log Rank P=0.001 (Figure 1). The 1-year survival rates in both groups were similar (93,9% vs 93,4%, Log Rank P=</span></span></span> <span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#201f1e">0,741&ndash; Figure 2). After adjustment for age, chronic kidney disease, chronic obstructive pulmonary disease, previous myocardial infarction, HF and LV ejection fraction, PCI almost halved the composite endpoint &ndash; HR 0.49 (95% CI 0.35-0.68) when compared to CABG, while all the other variables in the regression model remained significant predictors of the composite endpoint. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#201f1e">Conclusion: </span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#201f1e">PCI was superior to CABG for diabetic patients presenting with NST-ACS and multivessel CAD in preventing a composite endpoint of one-year death or hospitalization. No differences were observed for one-year mortality. </span></span></span></span></span></p>