Objectives To evaluate and analysis the clinical efficacy and prognosis of two different strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and coronary artery bypass graft (CABG) in old woman diabetic patients with complex coronary disease.
Background Elder, Female and Diabetic is markeble risk factor for poor prognosis after PCI and CABG. Which strategy of revascularization (PCI vs CABG) and the influence factor that could promote the choice of strategy for revascularization may be result in better outcome is uncertain in these patients. Further evaluations in adequately data are awaited to confirm the clinical benefit of two strategy.
Methods 523 female patients whose age were above 75 years old with DM, multivessel disease underwent PCI (206) or CABG (317) were included studied. The choice of revascularization was dependent on clinical baseline and procedural characteristics of patients and/or physician recommendation. Major adverse cardiac events (MACE) included death, myocardial infarction and repeat coronary revascularization.
Results MACE rates at 1 year is equivalent between CABG and PCI (2.1% vs 4.2% (OR 1.8; p>0.5). There was a similar risk of the combined endpoints of death (1.5% vs 2.8%), myocardial infarction (1.2% vs 1.6%) and cerebrovascular events (1.1% vs 2.3%) at 1 year, but the risk of target vessel revascularisation (TVR) was significantly higher (1.8% vs 7.8%, p<0.01). Compared with PCI patients, the lesions seem more complex. the prevalence of calcified lesions, total occlusion, collateral circulation were higher in CABG patients (p<0.01). The number of the diseased vessels was the only independent predictors of type of revascularization (PCI vs CABG).
Conclusions PCI with DES placement was safe compared to CABG as a type of revascularization in elder female patients with DM and MVD at 1-year. A clinical strategy for revascularization by PCI or CABG should be carefully assessed.