Causes of Death After Coronary Revascularization in Patients With Diabetes.

Abstract

In patients with diabetes and multivessel coronary artery disease, percutaneous coronary intervention (PCI) has been associated with higher long-term cardiovascular mortality compared with coronary artery bypass grafting (CABG), but the specific causes of death are not well known. We aimed to determine the causes of death of patients with diabetes and multivessel disease undergoing coronary revascularization with PCI vs CABG. We analyzed the centrally adjudicated causes of death of 1900 participants in the FREEDOM trial. Cause-specific hazard ratios (csHRs) were used to compare mortality rates. There were 197 deaths during the 5 years of follow-up; 63.5% were classified as cardiovascular deaths and the remaining (36.5%), noncardiovascular deaths. Sudden cardiac death was the most common cause of cardiovascular mortality (40% of all cardiovascular deaths), followed by myocardial infarction deaths (16% of all cardiovascular deaths). Compared with CABG, PCI was associated with increased ischemia-related mortality, namely, sudden cardiac death (csHR, 2.04; 95% CI, 1.13-3.70; P = .02) and the composite of sudden cardiac death and myocardial infarction death (csHR, 2.10; 95% CI, 1.27-3.48, P = .004). PCI was associated with a nonsignificant increase in overall cardiovascular mortality compared with CABG (csHR, 1.35; 95% CI, 0.95-1.93; P = .09). Sudden cardiac death was the most common cause of long-term mortality of patients with diabetes and multivessel coronary artery disease undergoing a revascularization procedure. Compared with CABG, PCI was associated with increased long-term rates of ischemia-related mortality. Operative techniques and secondary prevention should target reducing post-revascularization spontaneous myocardial infarction in patients treated with PCI.