Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease

Umme Rumana; Richard Kones; Montather O Taheer; Mohamed Elsayed; Craig W Johnson

doi:10.3390/jcdd6040041

Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease

J Cardiovasc Dev Dis. 2019 Nov 18;6(4):41. doi: 10.3390/jcdd6040041.

Authors

Umme Rumana^{1

2}, Richard Kones², Montather O Taheer³, Mohamed Elsayed³, Craig W Johnson¹

Affiliations

¹ The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics, Houston, TX 77030, USA.
² Cardiology Section, Director, The Cardiometabolic Research Institute, Houston, TX 77054, USA.
³ The New York Institute of Technology, Old Westbury, New York, NY 11568, USA.

Abstract

In diabetes patients with chronic ≥3 vessel disease, coronary artery bypass grafting (CABG) holds a class I recommendation in the American College of Cardiology and American Heart Association (ACC/AHA) 2011 guidelines, and this classification has not changed to date. Much of the literature has focused upon whether CABG or percutaneous coronary intervention (PCI) produces better outcomes; there is a paucity of data comparing the odds of receiving these procedures. A secondary analysis was conducted in a de-identified database comprised of 30,482 patients satisfying the entry criteria. Odds of occurrence (CABG, PCI) were determined as the binary dependent variable in period 1, (17 October 2009 through 31 December 2011), and period 2 (1 January 2013 through 16 March 2015), before and after the 2011 guidelines, while controlling for gender, ethnicity/race, and ischemic heart disease as covariates. The odds of performing CABG rather than PCI in period 2 were not statistically significantly different than in period 1 (p = 0.400). The logistic regression model chi-square statistic was statistically significant, with χ₂ (7) = 308.850, p < 0.0001. The Wald statistic showed that ethnicity/race (African American, Caucasian, Hispanic and Other), gender, and heart disease contributed significantly to the prediction model with p < 0.05, but ethnicity 'Unknown' did not. The odds of CABG versus PCI in period 2 were 0.98 times those in period 1 95% confidence interval (CI) = (0.925, 1.032), statistically controlling for covariates. There was no significant rise in the odds of undergoing a CABG among this dataset of high-risk patients with diabetes and multivessel coronary heart disease. Modern practice has evolved regarding patient choice and additional variables that impact the final revascularization method employed. The degree to which odds of occurrence of procedures are a reliable surrogate for provider compliance with guidelines remains uncertain.

Keywords: cardiovascular outcomes; coronary artery bypass graft; coronary heart disease; coronary revascularization; diabetes mellitus; percutaneous coronary intervention.