Everolimus-Eluting Stents or Bypass Surgery for Multivessel Disease in Diabetics: The BEST Extended Follow-Up Study

Kim H 1 , Kang DY 1 , Ahn JM 2 , Lee J 1 , Choi Y 1 , Hur SH 3 Show all authors , Park HJ 4 , Tresukosol D 5 , Kang WC 6 , Kwon HM 7 , Rha SW 8 , Lim DS 9 , Jeong MH 10 , Lee BK 11 , Huang H 12 , Lim YH 13 , Bae JH 14 , Kim BO 15 , Ong TK 16 , Ahn SG 17 , Chung CH 1 , Park DW 1 , Park SJ 1 , BEST Extended Follow-Up Study Investigators

Affiliations 

  • 1 Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2 Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: drjmahn@gmail.com
  • 3 Keimyung University Dongsan Medical Center, Daegu, Korea
  • 4 Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
  • 5 Siriraj Hospital, Bangkok, Thailand
  • 6 Gachon University Gil Hospital, Incheon, Korea
  • 7 Gangnam Severance Hospital, Seoul, Korea
  • 8 Korea University Guro, Seoul, Korea
  • 9 Anam Hospital, Seoul, Korea
  • 10 Chonnam National University Hospital, Gwangju, Korea
  • 11 Kangwon National University Hospital, Chuncheon, Korea
  • 12 Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
  • 13 Hanyang University Hospital, Seoul, Korea
  • 14 Konyang University Hospital, Daejeon, Korea
  • 15 Inje University Sanggye Paik Hospital, Seoul, Korea
  • 16 Sarawak General Hospital, Kuching, Sarawak, Malaysia
  • 17 Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
JACC Cardiovasc Interv, 2023 Oct 09;16(19):2412-2422.
PMID: 37821187 DOI: 10.1016/j.jcin.2023.07.028

Abstract

BACKGROUND: Diabetes mellitus is associated with more complex coronary artery diseases. Coronary artery bypass grafting (CABG) is a preferred revascularization strategy over percutaneous coronary intervention (PCI) in diabetics with multivessel coronary artery disease (MVD).

OBJECTIVES: This study sought to examine the different prognostic effects of revascularization strategies according to the diabetes status from the randomized BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease) trial.

METHODS: Patients (n = 880) with MVD were randomly assigned to undergo PCI with an everolimus-eluting stent vs CABG stratified by diabetics (n = 363) and nondiabetics (n = 517). The primary endpoint was the composite of death, myocardial infarction, or target vessel revascularization during a median follow-up of 11.8 years (IQR: 10.6-12.5 years).

RESULTS: In diabetics, the primary endpoint rate was significantly higher in the PCI group than in the CABG group (43% and 32%; HR: 1.53; 95% CI: 1.12-2.08; P = 0.008). However, in nondiabetics, no significant difference was found between the groups (PCI group, 29%; CABG group, 29%; HR: 0.97; 95% CI: 0.67-1.39; P = 0.86; Pinteraction= 0.009). Irrespective of the presence of diabetes, no significant between-group differences were found in the rate of a safety composite of death, myocardial infarction, or stroke and mortality rate. However, the rate of any repeat revascularization was significantly higher in the PCI group than in the CABG group.

CONCLUSIONS: In diabetics with MVD, CABG was associated with better clinical outcomes than PCI. However, the mortality rate was similar between PCI and CABG irrespective of diabetes status during an extended follow-up. (Ten-Year Outcomes of Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST Extended], NCT05125367; Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST], NCT00997828).

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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