Angiographic complete revascularization versus incomplete revascularization in patients with diabetes mellitus

Hwang, Doyeon; Park, Jiesuck; Yang, Han–Mo; Yang, Seokhun; Kang, Jeehoon; Han, Jung‐Kyu; Park, Kyung Woo; Kang, Hyun–Jae; Koo, Bon‐Kwon; Kim, Hyo–Soo

doi:10.1186/s12933-022-01488-7

Cited by 3 publications

(3 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These explanations are consistent with the results of recent observational and meta-analysis studies comparing multivessel PCI with DES and CABG [ 22 – 24 ]. Additionally, a recent study showed that the clinical long-term benefit of complete revascularization with relief of residual CAD is more prominent in patients with versus without DM (POCO [patient-oriented composite outcome]; aHR: 0.70; 95% CI: 0.52–0.93, p = 0.016) [ 25 ]. However, stent implantation at all visible coronary lesions is not practical or appropriate.…”

Section: Discussionmentioning

confidence: 99%

Drug-coated balloon-based versus drug-eluting stent-only revascularization in patients with diabetes and multivessel coronary artery disease

Her

Shin

Kim

et al. 2023

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background Data on drug-coated balloon (DCB) treatment in the context of diabetes mellitus (DM) and multivessel coronary artery disease (CAD) are limited. We aimed to investigate the clinical impact of DCB-based revascularization on percutaneous coronary intervention (PCI) in patients with DM and multivessel CAD. Methods A total of 254 patients with multivessel disease (104 patients with DM) successfully treated with DCB alone or combined with drug-eluting stent (DES) were retrospectively enrolled (DCB-based group) and compared with 254 propensity-matched patients treated with second-generation DES from the PTRG-DES registry (n = 13,160 patients) (DES-only group). Major adverse cardiovascular events (MACE) comprised cardiac death, myocardial infarction, stroke, stent or target lesion thrombosis, target vessel revascularization, and major bleeding at 2 years. Results The DCB-based group was associated with a reduced risk of MACE in patients with DM (hazard ratio [HR] 0.19, 95% confidence interval [CI] 0.05–0.68, p = 0.003], but not in those without DM (HR 0.52, 95% CI 0.20–1.38, p = 0.167) at the 2-year follow-up. In patients with DM, the risk of cardiac death was lower in the DCB-based group than the DES-only group, but not in those without DM. In both patients with or without DM, the burdens of DES and small DES (less than 2.5 mm) used were lower in the DCB-based group than in the DES-only group. Conclusions In multivessel CAD, the clinical benefit of a DCB-based revascularization strategy appears to be more evident in patients with DM than in those without DM after 2 years of follow-up. (Impact of Drug-Coated Balloon Treatment in De Novo Coronary Lesion; NCT04619277)

show abstract

Section: Discussionmentioning

confidence: 99%

Drug-coated balloon-based versus drug-eluting stent-only revascularization in patients with diabetes and multivessel coronary artery disease

Her

Shin

Kim

et al. 2023

Cardiovasc Diabetol

View full text Add to dashboard Cite

show abstract

“…Our institutional dose of prasugrel differs from conventional dosing as described above. 14 However, the modified dose of prasugrel has shown to have similar efficacy with a lower risk of bleeding in certain patient populations 23,24 . Lastly, we utilised all-cause mortality, not cardiovascular mortality in the assessment of the primary outcome, since the information on the cause of death is not available in this registry.…”

Section: Limitationsmentioning

confidence: 99%

Real-World Comparison of Clopidogrel with Ticagrelor and Prasugrel In Patients with Chronic Coronary Disease undergoing Atherectomy

Khan,

Koshy,

Tanner

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: In patients with chronic coronary disease (CCD), it is unclear whether the use of potent P2Y12 inhibitors (ticagrelor or prasugrel) offers advantages to clopidogrel when prescribed in conjunction with aspirin in patients undergoing percutaneous coronary intervention (PCI) with atherectomy. Methods: Consecutive patients undergoing PCI with atherectomy for CCD at a tertiary care center between January 2011 to December 2020 were included. Patients discharged on ticagrelor or prasugrel were compared to patients on clopidogrel. The primary outcome was a composite of death or myocardial infarction (MI), secondary outcomes included individual components of the primary outcome, stroke, major bleeding, and target vessel revascularization at 1 year. Adjusted analyses were performed using propensity score stratification. Results: Overall, 3,612 patients undergoing atherectomy were included in the analysis (clopidogrel [70.4%, n= 2,543], ticagrelor/prasugrel [29.5%, n=1,069]). Clopidogrel was prescribed more often in older patients with multimorbid risk factors, whereas ticagrelor/prasugrel was used more in patients with greater anatomical and procedural complexity. There was an increase in the use of potent antiplatelet agents over time (p<0.001). At 1-year follow-up, the primary outcome was observed in 5.2% and 4.0% of those taking clopidogrel and ticagrelor/prasugrel, respectively (adjusted hazard ratio (AHR) 0.87, 95% CI 0.58 – 1.3, p = 0.50). There were no significant differences in the rate of bleeding (5.5% vs 3.7%, AHR 0.98, 95% CI 0.66 - 1.46, p = 0.92) or other secondary outcomes between the two groups. Conclusion: The use of clopidogrel was associated with comparable ischemic and bleeding outcomes compared to ticagrelor/prasugrel in patients with CCD undergoing PCI with atherectomy.

show abstract

“…We used the residual SYNTAX score to quantify complete revascularization (CR). Angiographic CR was defined as a residual SYNTAX score of 0 (19)(20)(21). All SYNTAX scores were quantified by experienced independent analysts at Tianjin Chest Hospital.…”

Section: Study Population and Definitionsmentioning

confidence: 99%

Culprit vessel vs. immediate multivessel vs. out-of-hospital staged intervention for patients with non-ST-segment elevation myocardial infarction and multivessel disease

Wang

Lang

Zhang

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Background and aimsThe optimal interventional strategy remains undetermined in hemodynamically stable patients with NSTEMI and MVD. This study aimed to examine clinical prognosis among culprit vessel, immediate multivessel, and staged percutaneous coronary intervention (PCI) in patients with NSTEMI and MVD.MethodsThis retrospective, observational, single-center study included 943 hemodynamically stable patients with NSTEMI and MVD who had undergone successful drug-eluting stent (DES) implantation from January 2014 to December 2019. Patients were categorized into culprit lesion-only PCI (CL-PCI), immediate multivessel PCI (MV-PCI), and out-of-hospital staged MV-PCI according to PCI strategy. The primary outcome was the composite of major adverse cardiac events (MACEs), including all-cause death, myocardial infarction (MI), or unplanned repeat revascularization. The secondary outcomes were all-cause death, cardiac death, MI, and unplanned repeat revascularization.ResultsOver a median follow-up of 59 months, immediate MV-PCI was associated with a lower risk of all-cause death than CL-PCI (HR: 0.591, 95%CI: 0.364–0.960, P = 0.034). Out-of-hospital staged MV-PCI was associated with a reduced risk of MACE (HR: 0.448, 95%CI: 0.314–0.638, P < 0.001) and all-cause death (HR: 0.326, 95%CI: 0.183–0.584, P < 0.001) compared with CL-PCI. The above results were accordant after multivariate COX analysis and propensity score matching. MACE (HR: 0.560, 95%CI: 0.385–0.813, P = 0.002) and repeat revascularization (HR: 0.627, 95%CI: 0.400–0.982, P = 0.041) were significantly less likely to occur with out-of-hospital MV-PCI rather than immediate MV-PCI. However, the incidences of primary and secondary outcomes were comparable between immediate and staged PCI after confounder adjustment using multivariate regression and propensity score matching analysis. For subgroup analyses stratified by synergy between PCI with taxus and cardiac surgery score, staged MV-PCI was found to lower the risk of MACE compared with immediate MV-PCI in patients with more complex coronary disease.ConclusionHemodynamically stable patients with NSTEMI and MVD benefited from the strategy of MV-PCI. Patients with complex coronary anatomy treated with out-of-hospital staged MV-PCI rather than immediate MV-PCI had lower risks of MACE. These need to be confirmed in the future randomized study.

show abstract

Angiographic complete revascularization versus incomplete revascularization in patients with diabetes mellitus

Cited by 3 publications

References 40 publications

Drug-coated balloon-based versus drug-eluting stent-only revascularization in patients with diabetes and multivessel coronary artery disease

Drug-coated balloon-based versus drug-eluting stent-only revascularization in patients with diabetes and multivessel coronary artery disease

Real-World Comparison of Clopidogrel with Ticagrelor and Prasugrel In Patients with Chronic Coronary Disease undergoing Atherectomy

Culprit vessel vs. immediate multivessel vs. out-of-hospital staged intervention for patients with non-ST-segment elevation myocardial infarction and multivessel disease

Contact Info

Product

Resources

About