Long-Term Mortality with Contemporary Multivessel PCI Versus CABG in Patients with Diabetes and Multivessel Disease: A Population-Based Retrospective Cohort Study
- 1University of Alberta
Abstract
BackgroundCoronary artery bypass grafting (CABG) is often preferred over percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) and multivessel coronary artery disease (MVD), but whether it confers a long-term survival advantage remains unclear. Moreover, whether anatomic complexity modulates this relationship is unknown.
MethodsWe included 5,615 patients with diabetes and MVD who underwent revascularization with contemporary drug-eluting stents (PCI-DES; n=3,410) or CABG (n=2,205) in Alberta, Canada, between 2009 and 2019. The primary outcome was 5-year all-cause mortality. Secondary outcomes were 5-year major adverse cardiovascular events (MACE) and 10-year mortality and MACE in an earlier-era subcohort of 2,103 patients. Inverse probability of treatment weighting with Cox proportional hazards models was used. Interactions between revascularization, Duke Jeopardy Score (DJS), and clinical presentation (stable angina, unstable angina/NSTEMI, or STEMI) were examined.
ResultsFive-year all-cause mortality did not differ between PCI-DES and CABG (HR, 1.14; [95% CI,0.99-1.31]; P=0.08). However, PCI-DES was associated with a higher 5-year MACE (HR, 1.23; [95% CI,1.10-1.38]; P=0.0004), but lower 10-year all-cause mortality compared to CABG (HR,0.85; [95% CI,0.72-0.99]; P=0.04) with no difference in MACE (HR, 0.97; 95 % CI: 0.85-1.11; P=0.68). Anatomic complexity modified these findings, with lower 5-year mortality after CABG only at higher DJS (Pinteraction=0.003), and lower 10-year mortality after PCI-DES only at lower DJS (Pinteraction<0.0001).
ConclusionsIn patients with diabetes and MVD, 5-year all-cause mortality did not differ significantly between groups, although PCI-DES was associated with higher 5-year MACE rates. At 10 years, multivessel PCI-DES was associated with lower 10-year mortality and no difference in MACE. Anatomic complexity modified the effects, favouring CABG at higher DJS and PCI-DES at lower DJS. Our findings should be considered when planning revascularization in diabetes with MVD.
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BibTeX
@misc{xiao2026longterm,
title = {{Long-Term Mortality with Contemporary Multivessel PCI Versus CABG in Patients with Diabetes and Multivessel Disease: A Population-Based Retrospective Cohort Study}},
author = {X. Xiao and A. Savu and K. Bainey and D. T. Eurich and R. K. Sandhu and P. Kaul},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.04.26362312},
url = {https://www.medrxiv.org/content/10.64898/2026.09.04.26362312v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Long-Term Mortality with Contemporary Multivessel PCI Versus CABG in Patients with Diabetes and Multivessel Disease: A Population-Based Retrospective Cohort Study
AU - X. Xiao
AU - A. Savu
AU - K. Bainey
AU - D. T. Eurich
AU - R. K. Sandhu
AU - P. Kaul
PY - 2026
DA - 2026/09/04
PB - medRxiv
DO - 10.64898/2026.09.04.26362312
UR - https://www.medrxiv.org/content/10.64898/2026.09.04.26362312v1
AB - BackgroundCoronary artery bypass grafting (CABG) is often preferred over percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) and multivessel coronary artery disease (MVD), but whether it confers a long-term survival advantage remains unclear. Moreover, whether anatomic complexity modulates this relationship is unknown. MethodsWe included 5,615 patients with diabetes and MVD who underwent revascularization with contemporary drug-eluting stents (PCI-DES; n=3,410) or CABG (n=2,205) in Alberta, Canada, between 2009 and 2019. The primary outcome was 5-year all-cause mortality. Secondary outcomes were 5-year major adverse cardiovascular events (MACE) and 10-year mortality and MACE in an earlier-era subcohort of 2,103 patients. Inverse probability of treatment weighting with Cox proportional hazards models was used. Interactions between revascularization, Duke Jeopardy Score (DJS), and clinical presentation (stable angina, unstable angina/NSTEMI, or STEMI) were examined. ResultsFive-year all-cause mortality did not differ between PCI-DES and CABG (HR, 1.14; [95% CI,0.99-1.31]; P=0.08). However, PCI-DES was associated with a higher 5-year MACE (HR, 1.23; [95% CI,1.10-1.38]; P=0.0004), but lower 10-year all-cause mortality compared to CABG (HR,0.85; [95% CI,0.72-0.99]; P=0.04) with no difference in MACE (HR, 0.97; 95 % CI: 0.85-1.11; P=0.68). Anatomic complexity modified these findings, with lower 5-year mortality after CABG only at higher DJS (Pinteraction=0.003), and lower 10-year mortality after PCI-DES only at lower DJS (Pinteraction<0.0001). ConclusionsIn patients with diabetes and MVD, 5-year all-cause mortality did not differ significantly between groups, although PCI-DES was associated with higher 5-year MACE rates. At 10 years, multivessel PCI-DES was associated with lower 10-year mortality and no difference in MACE. Anatomic complexity modified the effects, favouring CABG at higher DJS and PCI-DES at lower DJS. Our findings should be considered when planning revascularization in diabetes with MVD.
ER -