Comparative Effectiveness of CABG Surgery and PCI with Second-Generation Drug-Eluting Stents in Elderly Patients with Type 2 Diabetes

Medicine

ABSTRACT With advances in the interventional field, the choice between second-generation drug-eluting stents percutaneous coronary intervention (DES-PCI) and coronary artery bypass grafting (CABG) for elderly patients with type 2 diabetes mellitus (T2DM) and multivessel coronary artery disease (CAD) remains controversial. This study aimed to compare long‑term clinical outcomes, including major adverse cardiovascular and cerebrovascular events (MACCE), its components, cardiac mortality, and rehospitalization for angina, between second‑generation DES‑PCI and CABG in this subset. This single-center retrospective cohort study included 400 elderly patients with T2DM and multivessel CAD who underwent myocardial revascularization (second-generation DES-PCI or CABG) between March 2013 and September 2020. MACCE was defined as a composite of all‑cause mortality, MI, stroke, and repeat revascularization. Event-free survival was evaluated using the Kaplan-Meier method with the log-rank test. Univariable and multivariable Cox proportional hazards regression with robust standard errors were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). After multivariable adjustment, at 5-years, DES-PCI versus CABG showed significantly higher risks of MACCE (HR 1.55; 95% CI 1.05–2.29; p = 0.026), repeat revascularization (HR 2.19; 95% CI 1.24–3.86; p = 0.007), and rehospitalization for angina (HR 1.87; 95% CI 1.12–3.12; p = 0.017). No statistically significant differences were found for the composite of cardiac mortality/MI/stroke, all‑cause mortality, cardiac mortality, MI, or stroke (all p > 0.05). Compared with CABG, second-generation DES-PCI was significantly associated with higher incidence of MACCE, mainly driven by repeat revascularization. No statistically significant differences were found in hard endpoints (all‑cause mortality, cardiac mortality, MI, stroke).

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