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Impact of Diabetes Mellitus on the Treatment Effect of Percutaneous or Surgical Revascularization for Patients With Unprotected Left Main Coronary Artery Disease

A Subgroup Analysis of the MAIN-COMPARE Study

Won-Jang Kim, MD, PhD^_*, Duk-Woo Park, MD, PhD^_*, Sung-Cheol Yun, PhD, Jong-Young Lee, MD^_*, Seung-Whan Lee, MD, PhD^_*, Young-Hak Kim, MD, PhD^_*, Cheol Whan Lee, MD, PhD^_*, Seong-Wook Park, MD, PhD^_*, Seung-Jung Park, MD, PhD^_*,_*

^_* Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea

^_* Reprint requests and correspondence: Dr. Seung-Jung Park, Department of Cardiology, University of Ulsan College of Medicine, Cardiac Center, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea (Email: sjpark{at}amc.seoul.kr).

Objectives: This study sought to investigate whether the outcome of drug-eluting stent (DES) treatment and that of coronary artery bypass grafting (CABG) differed in diabetic and nondiabetic patients with unprotected left main coronary artery (LMCA) disease.

Background: Diabetes mellitus has been shown to be a risk factor for adverse events and a major determinant in selection of a revascularization strategy in patients with multivessel or LMCA disease.

Methods: A total of 1,474 patients with unprotected LMCA stenosis who received DES (n = 784) or underwent CABG (n = 690) were examined. We compared the effects of these 2 treatments on long-term clinical outcomes (death; the composite of death, Q-wave myocardial infarction [MI], or stroke; and target vessel revascularization [TVR]), according to diabetic status.

Results: After adjustment of covariates, the risk of death (hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.62 to 1.46, p = 0.83) and the composite of death, Q-wave MI, or stroke (HR: 0.96, 95% CI: 0.65 to 1.42, p = 0.85) at 3 years were similar in the DES and CABG groups. However, the rate of TVR was significantly higher in the DES group (HR: 4.31, 95% CI: 2.28 to 8.15, p < 0.001). These trends were consistent in both diabetic and nondiabetic patients. We also did not observe a diabetes-associated excess risk of death (p_interaction = 0.90 and 0.16), or a composite of death, Q-wave MI, or stroke (p_interaction = 0.68 and 0.93), or TVR (p_interaction = 0.23 and 0.92), between patients receiving either treatment.

Conclusions: The prognostic impact of diabetes on long-term treatment with DES or CABG for patients with unprotected LMCA disease was minimal.

Key Words: stent • coronary artery bypass graft • diabetes mellitus • left main coronary artery disease

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CI = confidence interval   DES = drug-eluting stent(s)   HR = hazard ratio   IPTW = inverse probability of treatment weighting   LMCA = left main coronary artery   MI = myocardial infarction   PCI = percutaneous coronary intervention   TVR = target vessel revascularization

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