LONG-TERM (FOLLOW-UP TO 4 YEARS) RESULTS OF CORONARY ARTERY BYP ASS GRAFT AND PERCUTANEOUS CORONARY INTERVENTION IN NATIVE MULTIVESSEL CORONA RY ARTERY DISEASE FOR PATIENTS WITH DIABETES MELLITUS

Long-term survival of patients undergoing myocardial revascularization with multivessel disease is associated with the completeness of coronary artery revascularization. This is largely true for patients with diabetes mellitus (DM).
The aim of this study was to evaluate the long-term overall and cardiovascular survival of patients after coronary bypass surgery (CABG) or percutaneous coronary intervention (PCI) with native multivessel disease in patients with diabetes mellitus compared with patients without diabetes.
Material and methods. A prospective non-randomized study included 1192 people with significant multivessel coronary artery disease who underwent CABG or PCI for this reason in 2018-2022. The choice of the revascularization method was determined by the decision of the cardioteam, which included a cardiologist, an X-ray surgeon, and a cardiovascular surgeon. 426 patients underwent CABG and 766 patients received PCI with coronary stent implantation. Of these, 25.5% (304 patients) had type II DM detected before intervention. Glycated hemoglobin (HbA1c) and PGS (Patient Glycemic Status) were determined before surgery in all patients with DM, fasting glycated hemoglobin was divided into < 6.5%, < 7.0%, < 7.5%, < 8, 0% and 8.0% and above. PGS was divided into less than 35, 35-100, 100-150 and above 150.
In all patients, before and after revascularization, the initial (iSS) and residual (rSS) SYNTAX score (SS) were determined. According to their levels, patients were divided into iSS less than 23, iSS 23-32 and iSS above 32. Postoperative calculation of rSS was also carried out: rSS=0 (complete revascularization) and rSS>0 (incomplete revascularization), and it was subdivided into rSS=1-4, rSS=5-8, rSS>8.
Results. Hospital survival in the CABG group was 99.5%, and in the PCI group 99.8% (P=NS). In the DM subgroup after CABG, in-hospital survival was 99.1%, and after PCI it was 99.4% (P=NS).
Long-term survival up to 4 years was 93.2% in the CABG group and 94.1% in the PCI group. Among patients with DM, the long-term survival up to 4 years was 81.0% in the CABG group, and 83.5% in the PCI group.
The level of glycated hemoglobin above 7.5% and PGS=100-150 became significant predictors of in-hospital survival for CABG and PCI by univariate and multivariate regression analysis with sequential inclusion of variables. PGS over 100 and rSS>8 were significant predictors of long-term survival up to 4 years in the CABG and DM group, and rSS>0 was significant predictor of longterm survival in the PCI and DM group.
Conclusions. The immediate (inhospital) survival in patients with coronary artery disease and diabetes is affected by the level of glycated hemoglobin above 7.5% and PGS=100-150. Long-term survival up to 4 years after CABG is affected by a high residual SYNTAX index (rSS>8) and poor glycemic status of the patient (GSP) 100-150, and survival after PCI in the same period is affected by any incomplete coronary artery revascularization (rSS>0).

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