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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Elsevier
2025-06-01
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| Series: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542454825000153 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Thiago L. Scudeler, MD, PhD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-a7609d8bcf4d49bca1cb1ca7497d23f9 |
| institution | DOAJ |
| issn | 2542-4548 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| spelling | doaj-art-a7609d8bcf4d49bca1cb1ca7497d23f92025-08-20T03:10:20ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482025-06-019310060410.1016/j.mayocpiqo.2025.100604Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial InfarctionThiago L. Scudeler, MD, PhD0Leandro M. Alves da Costa, MD, PhD1José Roberto de Oliveira Silva Filho, MD2Rafael Amorim Belo Nunes, MD, PhD3Rafael Otto Schneidewind, MD4Thiago Midlej Brito, MD5Daniel Castanho Genta Pereira, MD, PhD6Roger Pereira de Oliveira, MD7Gabriela Chaves Santana, MD8Rodrigo Goldenstein Schainberg, MD9Anna Beatriz Gori Montes, MD10Leonardo Jorge Cordeiro de Paula, MD11Marco Alexander Valverde Akamine, MD12Helio Castello, MD, PhD13Marcelo José de Carvalho Cantarelli, MD, PhD14Álvaro Avezum Junior, MD, PhD15Department of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Correspondence: Address to Thiago L. Scudeler, MD, PhD, Hospital Alemão Oswaldo Cruz, Avenida 13 maio 1815, Bela Vista, São Paulo 01323-020, Brazil.Department of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilInstituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Cardiology, International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilInstituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilInstituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilDepartment of Cardiology, Emergency Department, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Cardiology, International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilObjective: 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.http://www.sciencedirect.com/science/article/pii/S2542454825000153 |
| spellingShingle | 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 Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| title | Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction |
| title_full | Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction |
| title_fullStr | Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction |
| title_full_unstemmed | Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction |
| title_short | Revascularization in Diabetic Patients With Non–ST-Elevation Acute Myocardial Infarction |
| title_sort | revascularization in diabetic patients with non st elevation acute myocardial infarction |
| url | http://www.sciencedirect.com/science/article/pii/S2542454825000153 |
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