Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes

Milojevic, Milan; Serruys, Patrick W.; Sabik, Joseph F.; Kandzari, David E.; Schampaert, Erick; Boven, Ad J. van; Horkay, Ferenc; Ungi, Imre; Mansour, Samer; Banning, Adrian P.; Taggart, David P.; Sabaté, Manel; Gershlick, Anthony; Bochenek, Andrzej; Pomar, José L.; Lembo, Nicholas; Noiseux, Nicolas; Puskas, John D.; Crowley, Aaron; Kosmidou, Ioanna; Mehran, Roxana; Ben‐Yehuda, Ori; Généreux, Philippe; Pocock, Stuart J.; Simonton, Charles A.; Stone, Gregg W.; Kappetein, Arie Pieter

doi:10.1016/j.jacc.2019.01.037

Cited by 74 publications

(86 citation statements)

References 25 publications

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“…1 Unfortunately, it was found that post-myocardial infarction complications and deaths are higher in diabetic patients after CABG or PTCA compared with non-diabetic patients. [3][4][5] A report analysis of EXCEL trial 21 documented that diabetic patients sustained a higher composite end point of death, stroke and MI after CABG (HR: 1.55; 95% CI: 1.04 to 2.31; p=0.03) or PTCA (HR: 1.53; 95% CI: 1.04 to 2.26; p=0.03) than non-diabetic population. Furthermore, in contrast to healthy individuals, diabetic patients suffered a higher rate of wound infection, neurological and renal complications, higher risk of stroke and readmission following CABG and increased rates of target lesion revascularization and reinfarction after PTCA.…”

Section: Discussionmentioning

confidence: 99%

Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

Musa¹,

Min²,

Rahim³

et al. 2020

JDMDC

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onset diabetes of the young; LADA, latent autoimmune diabetes of adulthood; MI, myocardial infarction; LMSD, left main stem disease; MVD, multivessel disease; DES, drug eluting stent; RCS, randomised controlled trials; OS, observational studies; BARI, bypass angioplasty revascularization investigation; MACCE, major adverse cardiac and cerebrovascular events; EES, everolimus-eluting stent; ACR, hybrid coronary revascularization diabetes. 1 Compared to non-diabetic patients, the rate of mortality and adverse events in patients with diabetes is significantly higher. 2-4 Early revascularization could enhance their prognosis. 5 Nonetheless, the long-term merits of utilising either CABG or PTCA remains debatable. Aim Our study aims to investigate whether diabetic patients fare better in the long term with PTCA compared to CABG. Methods We conducted a literature search dating from January 2010 to June 2020 using PubMed, MEDLINE, Cochrane and Embase database to identify relevant articles. Medical Subject Heading (MeSH) terms such as "diabetes mellitus" "Percutaneous Transluminal Coronary Angioplasty" and "Coronary Artery Bypass Surgery" were used to identify journal articles. To allow additional relevant references selected, cross checking of references was also performed. We included studies that were (1) published from January 2010 to June 2020 with a (2) minimum duration of patient follow-up of five years regarding (3) revascularization of patients with Type 2 diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

Musa¹,

Min²,

Rahim³

et al. 2020

JDMDC

View full text Add to dashboard Cite

show abstract

“…In a prespecified subgroup analysis from this trial, the occurrence of the composite of all-cause death, stroke or MI at 3 years was 60% higher in patients with DM (HR, 1.60; 95% CI, 1.26 to 2.04; p<0.001), further confirming the role of DM in longterm outcomes after coronary revascularization. No interaction was found between revascularization strategy and DM regarding occurrence of the composite of all-cause death, stroke or MI at 3 years (PCI vs CABG: HR, 1.03; 95% CI, 0.71 to 1.50; p¼0.87) (29). In patients with DM and higher SYNTAX score (between 23 and 32), all-cause mortality at 3 years was higher after PCI compared with CABG (19.6% vs 9.6%; p¼0.04), without, however, a significant interaction between SYNTAX score and revascularization strategy (p¼0.32 for interaction) (29).…”

Section: Left Main Diseasementioning

confidence: 93%

“…No interaction was found between revascularization strategy and DM regarding occurrence of the composite of all-cause death, stroke or MI at 3 years (PCI vs CABG: HR, 1.03; 95% CI, 0.71 to 1.50; p¼0.87) (29). In patients with DM and higher SYNTAX score (between 23 and 32), all-cause mortality at 3 years was higher after PCI compared with CABG (19.6% vs 9.6%; p¼0.04), without, however, a significant interaction between SYNTAX score and revascularization strategy (p¼0.32 for interaction) (29). In the meta-analysis by Head et al, CABG and PCI resulted in similar 5-year mortality rates in patients with DM and left main disease (n¼1,120; HR, 1.34; 95% CI, 0.93 to 1.91; p¼0.11) (14).…”

Section: Left Main Diseasementioning

confidence: 93%

Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus

Tavares

Farkouh

2020

Canadian Journal of Diabetes

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Key MessagesPatients with diabetes mellitus more frequently have diffuse and multivessel coronary artery disease. Coronary artery bypass surgery is the preferred revascularization strategy in most patients with diabetes. Special attention should be given to optimal control of risk factors in the postrevascularization setting. a b s t r a c t Patients with diabetes mellitus (DM) are at increased risk for developing coronary artery disease. Choosing the optimal revascularization strategy, such as coronary artery bypass grafting or percutaneous coronary intervention (PCI), may be difficult in this population. A large body of evidence suggests that, for patients with DM and stable multivessel ischemic heart disease, coronary artery bypass grafting is usually superior to PCI, leading to lower rates of all-cause mortality, myocardial infarction and repeat revascularization in the long term. In patients with less complex coronary anatomy (2-or single-vessel disease, especially without involvement of the proximal left anterior descendent artery), PCI may be a viable option. Because these anatomic patterns are less frequent in patients with DM, there is less evidence to guide revascularization in these cases. Patients with DM and left main disease and those in the acute coronary syndrome setting are also underrepresented in randomized trials, and the best revascularization strategy for these patients is not clear. Once the revascularization procedure is performed, patients should be kept engaged in controlling the risk factors for progression of cardiovascular disease. Avoidance of smoking, control of cholesterol, blood pressure and glycemic levels; regular practice of physical activity of at least moderate intensity; and a balanced diet are of key importance in the postrevascularization period. In this study, we review the current literature in the management of patients with DM and coronary artery disease undergoing a revascularization procedure.Ó 2019 Canadian Diabetes Association. Mots clés : maladie cardiovasculaire pontage aortocoronarien diabète intervention coronarienne percutanée r é s u m é Les patients atteints de diabète sucré (DS) sont exposés à un risque accru de coronaropathie. Le choix d'une stratégie de revascularisation optimale telle que le pontage aortocoronarien ou l'intervention coronarienne percutanée (ICP) peut être difficile pour cette population. De nombreuses données probantes montrent que chez les patients atteints de DS et d'une cardiopathie ischémique multitronculaire stable le pontage aortocoronarien offre généralement des résultats supérieurs à l'ICP, puisqu'il entraîne une diminution des taux de mortalité toutes causes confondues et de revascularisation répétée à long terme. Chez les patients qui ont une anatomie des artères coronaires moins complexe (maladie monotronculaire ou bitronculaire, particulièrement sans la contribution de l'artère interventriculaire Can J Diabetes 44 (2020) 78e85antérieure proximale), l'ICP peut être une option viable. Comme ces anatomies sont moins fréquentes c...

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“…Left main (LM) disease and three-vessel disease are types of complex coronary artery disease (CAD), the treatment of which is more difficult. Coronary artery bypass graft (CABG), as an effective treatment for CAD, has been introduced for more than 50 years, and it is currently the preferred modality for treating complex CAD [1,2]. However, over the last twenty years, there have been significant advances in percutaneous coronary intervention (PCI) from the era of balloon angioplasty and subsequent bare-metal stents to drug-eluting stents (DESs) [3].…”

Section: Introductionmentioning

confidence: 99%

Second Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease

Chen

Zhang

Yan

et al. 2020

Journal of Interventional Cardiology

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Background. Many studies have compared the outcomes of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for complex coronary artery disease (CAD). However, no trials have focused on young patients (<45 years) with complex CAD. We conducted a retrospective evaluation to compare the outcomes of a second-generation drug-eluting stent (DES) and CABG in young patients with LM or three-vessel disease. Methods. In young patients with complex CAD who underwent PCI or CABG, a Kaplan-Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiac and cerebrovascular events (MACCE), including myocardial infarction (MI), stroke, death, and repeat revascularization. Results. During follow-up, MACCE occurred in 20.5% of patients in the PCI group and 8.6% of patients in the CABG group (hazard ratio (HR): 3.263, 95% confidence interval (CI): 1.379 to 7.722, p=0.007). Repeat revascularization occurred more frequently in the PCI group (18.9% vs. 3.7%, respectively, HR: 6.968, 95% CI: 2.036 to 23.842, p=0.002). There were no significant differences in the other endpoints. After propensity score matching, no conclusions were modified. Conclusions. In young patients with LM or three-vessel disease, PCI showed a higher incidence of MACCE, which was mainly driven by repeat revascularization. However, this did not translate into hard endpoint differences. Therefore, PCI is an alternative treatment to CABG in young patients with complex CAD.

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Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes

Cited by 74 publications

References 25 publications

Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus

Second Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease

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