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

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 (rho(interaction) = 0.90 and 0.16), or a composite of death, Q-wave MI, or stroke (rho(interaction) 0.68 and 0.93), or TVR (rho(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. (J Am Coll Cardiol Intv 2009;2:956-63) (c) 2009 by the American College of Cardiology Foundation