SURVIVAL OUTCOMES AFTER LEFT MAIN CORONARY ARTERY BYPASS GRAFTING VERSUS STENTING IN DIABETIC PATIENTS: INSIGHTS FROM PAKISTAN

Abstract

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality, particularly among diabetic patients. The optimal revascularization strategy for diabetic patients with left main coronary artery disease remains controversial. This study compares the long-term survival outcomes and quality of life between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stenting in diabetic patients.

Methods: This prospective cohort study was conducted at a tertiary care hospital in Pakistan from January 2018 to December 2023. A total of 303 diabetic patients with left main coronary artery disease were randomized to receive either CABG (n=152) or PCI with stenting (n=151). Data on demographics, clinical histories, and outcomes were collected at baseline, 1 month, 6 months, 1 year, and annually up to 5 years. Primary outcomes included all-cause mortality and major adverse cardiac events (MACE). Secondary outcomes included rehospitalization for cardiac causes and quality of life assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Statistical analysis was performed using SPSS version 25.0, with survival curves estimated using the Kaplan-Meier method and comparisons made using the log-rank test.

Results: At the 5-year follow-up, the CABG group exhibited significantly lower rates of all-cause mortality (10% vs. 20%, p<0.05) and MACE (25% vs. 35%, p<0.05) compared to the PCI group. Rehospitalization rates were lower (30% vs. 45%, p<0.01), and quality of life scores were higher (25 ± 5 vs. 35 ± 6, p<0.01) in the CABG group. Cox proportional hazards regression analysis indicated that CABG was associated with a significantly lower hazard ratio for all-cause mortality and MACE after adjusting for covariates.

Conclusion: CABG offers superior long-term survival and quality of life compared to PCI in diabetic patients with left main coronary artery disease. These findings support CABG as the preferred revascularization strategy in this high-risk population, underscoring the need for personalized treatment planning in complex cardiac interventions.