Thread by @DrDamluji

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With or Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials: @CircAHA

🥸wow: more on left main+diabetes: PCI vs CABG!

😱 Summary

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1/ 🥸 Left main coronary artery disease and diabetes are associated with substantial cardiovascular morbidity and mortality.

2/ 🥸 Yet, long-term outcomes for patients with left main disease and diabetes undergoing PCI compared with CABG remain unclear.

3/ 🥸 Previous subgroup studies of individual randomized trials have attempted to address this issue but had limited power.

4/ 🥸 Moreover, registry-based studies have been constrained by biases and confounding.

5/🥸 Previous trials suggested that diabetes might modulate clinical outcomes, with a lower 5-year mortality rate in CABG patients but similar rates after PCI and CABG in non-diabetic patients.

6/ 🥸 The objective was to use pooled patient-level data from 4 major trials comparing PCI with CABG in patients with left main disease to examine outcomes in patients with versus without diabetes.

7/ 🥸 Data from SYNTAX, PRECOMBAT, NOBLE, and EXCEL trials were pooled and analyzed.

😱 Amazing!

8/ 🥸 Patients were categorized by the presence or absence of diabetes at baseline.

9/ 🥸 The primary endpoint was all-cause death through 5 years, with secondary endpoints including cardiovascular death, MI, stroke, and others.

10/ 🥸 Mortality rate at 10 years was also analyzed from 2 of the trials.

11/ 🥸 Statistical analysis involved comparing baseline characteristics and estimating time-to-event outcomes with Cox Proportional Hazards models.

🥸 Interactions between treatment effects and diabetes presence were evaluated for risk differences.

12/ 🥸 Exploratory analyses further stratified outcomes by diabetes treatment and compared event rates by treatment modality.

😱 The relationship between cardiovascular death and SYNTAX score in patients with and without diabetes was explored.

13/ 🥸 Among 4,394 patients with left main disease, nearly all had data on diabetes status, and showed 1,104 (25.1%) had diabetes, with 22.6% on insulin therapy.

14/ 🥸 Baseline characteristics, such as hypertension and dyslipidemia and multiple comorbidities, were more common in diabetic patients.

😱See table 👇

15/ 🥸 Diabetic patients experienced higher all-cause and cardiovascular death rates over 5 years compared to non-diabetics.

16/ 🥸 The risk remained even after adjusting for baseline differences, emphasizing the impact of diabetes on outcomes.

17/ 🥸 Despite diabetes, mortality rates after PCI and CABG were similar, with no significant difference observed

😱Look at this 👇👇👇

18/ 🥸 High SYNTAX scores in diabetics suggested an greater risk of cardiovascular death with PCI than CABG.

19/ 🥸 Across all patients, PCI was associated with lower early stroke risk but higher rates of MI and revascularization compared to CABG.

20/ 🥸 The findings highlight the need for a balanced discussion on revascularization strategies, especially in diabetic patients with left main disease.

21/ 🥸 This comprehensive analysis provides insights on shared decision-making in clinical practice, focusing on the trade-offs between PCI and CABG for left main disease +/- DM.

😱Excellent work...This needs an editorial @CircAHA

🥸 Have a nice day everyone!