Aims

The aim of this study is to investigate the long-term relationship between revascularization technique and health status in diabetics with multivessel disease.

Methods and results

Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry, we captured 1319 diabetics with multivessel disease requiring revascularization for an acute coronary syndrome (January 2009–December 2012) and reported health status using the Seattle Angina Questionnaire (SAQ) at baseline, 1, 3 and 5-years [599 underwent coronary artery bypass grafting (CABG); 720 underwent percutaneous coronary intervention (PCI)]. Adjusted analyses were performed using a propensity score-matching technique. After adjustment (including baseline SAQ domain scores), 1-year mean (95% CI) SAQ scores (range 0–100 with higher scores reflecting improved health status) were significantly greater in selected domains for CABG compared to PCI (exertional capacity: 81.7 [79.5–84.0] vs. 78.8 [76.5–81.0], P = 0.07; angina stability: 83.1 [80.4–85.9] vs. 75.0 [72.3–77.8], P < 0.001]; angina frequency 93.2 [91.6–95.0] vs. 90.0 [87.8–91.3], P = 0.003; treatment satisfaction: 93.6 [92.2–94.9] vs. 90.8 [89.2–92.0], P = 0.003; quality of life [QOL]: 83.8 [81.7–85.8] vs. 77.2 [75.2–79.2] P < 0.001). At 3-years, these benefits were attenuated (exertional capacity: 79.3 [76.9–81.7] vs. 78.7 [76.3–81.1], P = 0.734; angina stability 79.3 [76.3–82.3] vs. 75.5 [72.5–78.5], P = 0.080; angina frequency: 93.2 [91.3–95.1] vs. 90.9 [89.0–92.8], P = 0.095; treatment satisfaction: 92.5 [91.0–94.0] vs. 91.5 [90.0–93.0] P = 0.382; QOL: 83.2 [81.1–85.2] vs. 80.3 [78.2–82.4], P = 0.057). At 5-years, majority of domains were similar (exertional capacity: 77.8 [75.0–80.6] vs. 76.3 [73.2–79.3], P = 0.482; angina stability: 78.0 [74.8–81.2] vs. 74.8 [71.4–78.2], P = 0.175; angina frequency: 94.2 [92.3–96.0] vs. 90.9 [89.0–92.9], P = 0.018; treatment satisfaction: 93.7 [92.2–95.1] vs. 92.2 [90.6–93.7], P = 0.167; QOL: 84.1 [82.0–86.3] vs. 81.1 [78.8–83.4], P = 0.058). Majority in both groups remained angina-free at 5-years (75.0% vs. 70.3%, P = 0.15).

Conclusion

Improvements in health status with CABG compared with PCI were not sustained long-term. This temporal sequence should be considered when contemplating a revascularization strategy in diabetics with multivessel disease.

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