The Effect of Previous Coronary-Artery Bypass Surgery on the Prognosis of Patients with Diabetes Who Have Acute Myocardial Infarction
Open accessAbstract
BACKGROUND: Acute myocardial infarction in patients with diabetes is associated with high mortality. We studied whether previous revascularization by coronary-artery bypass grafting (CABG), as compared with percutaneous transluminal coronary angioplasty (PTCA), influences the prognosis in such patients. METHODS: We classified all patients eligible for the Bypass Angioplasty Revascularization Investigation who underwent coronary revascularization within three months after entry into the study according to whether they had diabetes and whether they had undergone CABG, either initially or after PTCA. The protective effect of CABG with regard to mortality in the presence and in the absence of subsequent spontaneous Q-wave myocardial infarction was estimated with the use of Cox regression models. RESULTS: Among the 641 patients with diabetes and the 2962 without diabetes, the cumulative five-year rates of death were 20 percent and 8 percent, respectively (P<0.001), and the five-year rates of spontaneous Q-wave myocardial infarction were 8 percent and 4 percent (P<0.001). CABG greatly reduced the risk of death after spontaneous Q-wave myocardial infarction in the patients with diabetes (relative risk, 0.09; 95 percent confidence interval, 0.03 to 0.29). Among patients with diabetes who had undergone CABG but did not have spontaneous Q-wave myocardial infarctions, the corresponding relative risk of death was 0.65 (95 percent confidence interval, 0.45 to 0.94). Among the patients without diabetes, no protective effect of CABG was evident. CONCLUSIONS: Among patients with diabetes, previous coronary bypass surgery, as compared with coronary angioplasty, has a highly favorable influence on prognosis after acute myocardial infarction and a smaller beneficial effect among patients who do not have infarction. These findings should influence the type of coronary revascularization procedure selected for patients with diabetes who have multivessel coronary artery disease.
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Much of the long-term advantage of CABG over balloon angioplasty came from a durable conduit that bypassed the entire proximal vessel, producing an early survival benefit after myocardial infarction in patients who received left internal mammary artery grafts.
“Much of the observed long-term benefit of CABG over balloon angioplasty was attributable to a durable surgical conduit bypassing the entire proximal vessel, resulting in a documented early survival advantage after myocardial infarction in patients treated with left internal mammary artery (IMA) grafts.280”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [280]
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References 30 · Cited by 171
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- Authors
- Detre, K. M., Lombardero, M. S., Brooks, M. M., Hardison, R. M., Holubkov, R., Sopko, G., Frye, R. L., & Chaitman, B. R.
- Affiliations
- University of Pittsburgh (US)
- National Institutes of Health (US)
- Mayo Clinic (US)
- Saint Louis University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2000-04-06
- Volume
- 342
- Issue
- 14
- Pages
- 989-997
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2314047347
- Cited by
- 171
- References
- 30
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 9 · 2019: 3 · 2017: 1 · 2016: 2 · 2015: 7 · 2014: 4 · 2013: 1 · 2012: 3
- FWCI
- 22.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction, diabetes mellitus, coronary revascularization, mortality, multivessel coronary artery disease, prognosis
- MeSH terms
- Aged, Coronary Artery Bypass, Coronary Disease, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Prognosis, Angioplasty, Balloon, Coronary, Proportional Hazards Models, Survival Analysis, Randomized Controlled Trials as Topic, Diabetes Complications
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