Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction

Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction

Objective: To compare the outcomes of diabetic patients hospitalized with non–ST-elevation myocardial infarction (NSTEMI) referred for coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in a real-world evidence population. Patients and Methods: This study assessed major...

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Main Authors: Thiago L. Scudeler, MD, PhD, Leandro M. Alves da Costa, MD, PhD, José Roberto de Oliveira Silva Filho, MD, Rafael Amorim Belo Nunes, MD, PhD, Rafael Otto Schneidewind, MD, Thiago Midlej Brito, MD, Daniel Castanho Genta Pereira, MD, PhD, Roger Pereira de Oliveira, MD, Gabriela Chaves Santana, MD, Rodrigo Goldenstein Schainberg, MD, Anna Beatriz Gori Montes, MD, Leonardo Jorge Cordeiro de Paula, MD, Marco Alexander Valverde Akamine, MD, Helio Castello, MD, PhD, Marcelo José de Carvalho Cantarelli, MD, PhD, Álvaro Avezum Junior, MD, PhD
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Mayo Clinic Proceedings: Innovations, Quality & Outcomes
Online Access:http://www.sciencedirect.com/science/article/pii/S2542454825000153
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Summary:Objective: To compare the outcomes of diabetic patients hospitalized with non–ST-elevation myocardial infarction (NSTEMI) referred for coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in a real-world evidence population. Patients and Methods: This study assessed major cardiovascular outcomes in diabetic patients who underwent myocardial revascularization, using data obtained on July 24, 2024, from TriNetX, a global health research network. Patients with diabetes mellitus and NSTEMI were identified using the International Classification of Diseases, Tenth Revision, diagnosis code. Main outcome measure was 5-year all-cause mortality. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patients. Results: A total of 18,115 patients with a mean age of 62.2 (SD, 8.98) years and a mean glycated hemoglobin A1c of 7.66% (SD, 2.18%) were included, of whom 8206 (45.3%) underwent CABG and 9909 (54.7%) underwent PCI. During the 5-year follow-up, 2275 (12.5%) deaths were recorded in all cohort. Propensity matching yielded a 1:1 match consisting of 7585 patients in each group (CABG vs PCI); CABG was associated with significantly lower all-cause mortality over 5 years of follow-up (10.6% vs 17.9%; hazard ratio, 0.685; 95% CI, 0.618-0.759; P<.0001). Myocardial infarction occurred more frequently in the PCI cohort (48.6% vs 43.3%; P<.0001). Additional coronary revascularization was higher for PCI patients at 5 years (14.5% vs 1.72%; P=.0229). Conclusion: In this real-world study of diabetic patients with NSTEMI, CABG was associated with a lower rate of all-cause mortality at 5 years when compared with PCI.
ISSN:2542-4548

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