Background: In patients with diabetes and multivessel coronary artery disease, percutaneous coronary intervention (PCI) has been associated with higher long-term cardiovascular mortality compared to coronary artery bypass grafting (CABG), but the specific causes of death are not well known. We aimed to determine the causes of death among patients with diabetes and multivessel disease undergoing coronary revascularization with PCI versus CABG.
Methods: We analyzed the centrally adjudicated causes of death of 1,900 participants in the FREEDOM trial. Cause-specific hazard ratios (csHR) were used to compare mortality rates.
Results: There were 197 deaths during the five years of follow-up, 63.5% were classified as cardiovascular deaths and the remaining (36.5%), non-cardiovascular deaths. Sudden cardiac death was the most common cause of cardiovascular mortality (40% of all cardiovascular deaths), followed by myocardial infarction deaths (16% of all cardiovascular deaths). Compared to CABG, PCI was associated with increased ischemic-related mortality, namely sudden cardiac death (csHR: 2.04;95%CI: 1.13 to 3.70; p=0.02) and the composite of sudden cardiac death and myocardial infarction death (csHR: 2.10, 95%CI: 1.27 to 3.48, p=0.004). PCI was associated with a non-significant increase in overall cardiovascular mortality compared to CABG (csHR: 1.35;95%CI: 0.95 to 1.93; p=0.09).
Conclusions: Sudden cardiac death was the most common cause of long-term mortality among patients with diabetes and multivessel coronary artery disease undergoing a revascularization procedure. Compared to CABG, PCI was associated with increased long-term rates of ischemic-related mortality. Operative techniques and secondary prevention should target reducing post-revascularization spontaneous myocardial infarction in patients treated with PCI.
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