Overall, patients with diabetes had lower 5-year rates of all-cause mortality (14.7% vs. 9.3%), spontaneous myocardial infarction (6.7% vs. 3.7%), and repeat revascularization (18.5% vs. 13.2%). It was associated with being expensive.

“Although it is already well established that diabetes, particularly diabetes on insulin therapy, is associated with high rates of adverse cardiovascular events, these findings demonstrate that the presence of left main coronary artery disease and diabetes are clearly at increased risk. “We present a scenario in which “optimization, cardiovascular risk reduction, and appropriate revascularization are possible,” and highlight the need for medical attention,” the authors wrote.

The study authors also compared outcomes after CABG and PCI. Although their all-cause mortality rates were similar, each approach also had unique clinical advantages. For example, CABG patients had a lower incidence of spontaneous myocardial infarction and repeated revascularization, whereas PCI patients had a lower 1-year stroke risk.

The researchers noted that these findings highlight the importance of providing individualized care to heart patients with left-sided main disease, with or without diabetes.

“Pooled individual patient-level data from four major randomized clinical trials on left-sided disease further clarify the trade-off between the two approaches,” they concluded. “These data can be used by collaborative cardiac teams to consider revascularization approaches and share decision-making with each patient.”

Click here to read the full study CirculationJournal of the American Heart Association.