Percutaneous Coronary Intervention vs Coronary Artery Bypass Graft In- hospital Outcomes in Diabetes

Abstract

Background: Despite extensive research on coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) outcome differences, current literature lacks representation of short-term in-hospital outcomes in patients with existing medical conditions. This study aimed to compare perioperative outcomes of these two revascularization procedures in diabetes mellitus (DM) patients. Methods: The National Inpatient Sample (NIS) was used to extract patients who received CABG or PCI surgery between the last quarter of 2015 to 2020 based on ICD10-PCS. Patients of age<40 were excluded for congenital heart defects. Preoperative differences were noted and adjusted using multivariable logistic regression. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were estimated between PCI and CAGB groups. Results: A total number of 90,662 CABG and 173,725 PCI cases of patients with DM were identified in NIS. Compared to CABG, patients who underwent PCI had increased mortality (2.75% vs 2.00%, aOR 1.266, p<0.0001), myocardial infarction (1.5% vs 1.17%, aOR 1.223, p<0.0001), and were less likely to experience respiratory events (0.38% vs 6.33%, aOR 0.055, p<0.0001), stroke (0.03% vs 0.06%, aOR 0.385, p<0.0001), acute kidney injury (20.37% vs 25.37%, aOR 0.727, p<0.0001), sepsis (0.01% vs 0.05%, aOR 0.172, p<0.0001), shock (0.11% vs 0.74%, aOR 0.139, p<0.0001). Conclusions: The NIS database collects enormous records from nationwide providers, offering great statistical power. PCI was associated with a markedly higher in-hospital mortality rate but a lower morbidity rate in patients with DM as compared to CABG. Therefore, physicians should weigh both mortality and morbidity when considering surgical treatment to DM patients.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used only openly available human data from The National (Nationwide) Inpatient Sample (NIS) that were originally located at https://hcup-us.ahrq.gov/databases.jsp

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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