SYNTAX: Increased MACCE Driven by Revascularization in Patients with Diabetes

Key Points:
• Data reveal significantly increased mortality compared with nondiabetics with both Taxus and CABG.
By TCT Daily Staff
Percutaneous coronary intervention with the Taxus stent is associated with higher rates of major adverse cardiac and cerebrovascular events than CABG in patients with diabetes, driven mainly by higher revascularization rates, according to data from a SYNTAX subanalysis presented Tuesday.

Keith D. Dawkins, MD, presented 12-month outcome data on a subgroup of SYNTAX patients with medically treated diabetes who were randomized to CABG or Taxus. 

Taxus implantation was found to be a significant predictor of MACCE in both diabetic (HR=2.72; P<.001) and nondiabetic patients (HR=1.46; P=.03), said Dawkins, of Boston Scientific Corporation.

A total of 511 patients in SYNTAX had diabetes. Of those, 452 were medically treated and were the focus of the subset analysis. Among that group, 57% had metabolic syndrome and 48% had HbA1c >7%. Additionally, 71% of patients with medically treated diabetes had three-vessel disease and 29% had any degree of left main disease, compared with 64.1% and 35.9% of patients without diabetes, respectively.

One-year outcome data
At one year, 26% of patients with medically treated diabetes assigned to Taxus had MACCE, compared with 14.2% of those assigned to CABG (P=.003). The researchers reported a nonsignificant difference in MACCE with Taxus compared with CABG in nondiabetic patients (15.1% vs. 11.8%; P=.08).

"MACCE in the nondiabetic was lower than in the diabetic. But in the diabetic patient there was a disproportionate amount of MACCE, which was driven by revascularization," Dawkins said (see Figure 1).

Revascularization rates of any vessel were higher among patients with diabetes assigned to Taxus (20.3%) compared with CABG (11.1%; P<.001). In the CABG group, revascul