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

  1. Arno Breeman, MD1,
  2. Michel E. Bertrand, PHD2,
  3. Jan Paul Ottervanger, PHD1,
  4. Sanne Hoeks, MSC3,
  5. Mattie Lenzen, MSC3,
  6. Udo Sechtem, PHD4,
  7. Victor Legrand, PHD5,
  8. Menko-Jan de Boer, PHD1,
  9. William Wijns, PHD6,
  10. Eric Boersma, PHD3 and
  11. on behalf of the investigators of the Euro Heart Survey on Coronary Revascularization *
  1. 1Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
  2. 2Lille Heart Institute, University of Lille, Lille, France
  3. 3Clinical Epidemiology Unit, Thoraxcenter Cardiology, Erasmus MC, Rotterdam, the Netherlands
  4. 4Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany
  5. 5Department of Cardiology, Centre Hospitalier Universitaire du Sart Tilman, Liege, Belgium
  6. 6Cardiovascular Center, Aalst, Belgium
  1. 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

Abstract

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.

Footnotes

  • *

    ↵* Members of the Euro Heart Survey on Coronary Revascularization can be found in the appendix.

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted May 8, 2006.
    • Received January 17, 2006.
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  1. doi: 10.2337/dc06-0118 Diabetes Care September 2006 vol. 29 no. 9 2003-2011
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