Bypasschirurgie versus perkutane koronare Intervention bei Patienten mit Diabetes mellitus

Dörr, R.

doi:10.1007/s00059-010-3342-2

Cited by 3 publications

(1 citation statement)

References 50 publications

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“…In der 2009 publizierten SYNTAX (SYNergy Between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery)-Studie, einem randomisierten Vergleich einer Mehrgefäß-PCI ("percutaneous coronary intervention") mit Paclitaxel-freisetzenden TA-XUS-Stents im Vergleich zur Bypass-Chururgie bei 1800 Patienten mit einer koronaren Mehrgefäßerkrankung und Hauptstammstenose, betrug die Diabetespräva-lenz 25%, davon waren 10% insulinpflichtige Diabetiker [7,8]. In der 2007 publizierten COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation)-Studie, einem randomisierten Vergleich einer optimierten medikamentösen Therapie (OMT) mit einer optimierten medikamentösen Therapie plus ergänzende Revaskularisation (PCI oder Bypass-Operation) an 2287 Patienten mit KHK, lag die Diabetesprävalenz im Durchschnitt bei 33% [9].…”

Section: Diabeteshäufigkeit Bei Koronarer Herzkrankheit In Großen Ranunclassified

Prevalence of undetected diabetes mellitus in invasive and interventional cardiology

Dörr

Stumpf²,

Spitzer³

et al. 2012

Herz

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In most randomized controlled trials on revascularization therapy for patients with ischemic coronary artery disease (CAD), the diabetes prevalence ranges between 15% and 35%. However, the true prevalence of diabetes is probably considerably underestimated in these trials. The European heart survey diabetes and the heart published in 2004 supplied strong evidence that there are many additional cases of undetected prediabetics and diabetics in any cardiology patient cohort. The long-term outcome of newly detected diabetics was found to be comparable to patients with already known diabetes mellitus. With this in mind, the Dresden silent diabetes study investigated the prevalence of undetected diabetes mellitus by oral glucose tolerance testing (OGTT) and comparative HbA1c sampling in 1,015 patients admitted for coronary angiography. Patients with known diabetes were excluded from the study.According to the OGTT only 513 patients (51%) were classified with normal glucose tolerance (NGT), 10 (1%) with isolated impaired fasting glucose (IFG), 349 (34%) with impaired glucose tolerance (IGT) and 143 (14%) were diagnosed with newly detected diabetes mellitus (DM). According to the HbA1c measurements 588 patients (58%) were classified as normal, 385 (38%) as borderline and only 42 (4%) were diagnosed with diabetes (DM). There was a significant correlation between the extent of CAD and glycemic status as defined by the OGTT. The number of patients with IGT and diabetes increased with the extent of CAD (IGT group p<0.001, diabetes group p=0.01). However, no such correlation was observed when glycemic status was defined by HbA1c testing.Based on these results an OGTT should be routinely performed in patients with known or suspected coronary artery disease undergoing coronary angiography for diagnosis of diabetes, as HbA1c measurements alone appear to miss a substantial proportion of patients. These findings are of high clinical relevance with regard to optimal coronary revascularization procedure chosen in catheterization laboratories, preferably drug-eluting stents in cases of diabetes mellitus or newly detected diabetes mellitus and preferably coronary bypass surgery in diabetics with multi-vessel disease and high SYNTAX scores.

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Section: Diabeteshäufigkeit Bei Koronarer Herzkrankheit In Großen Ranunclassified

Prevalence of undetected diabetes mellitus in invasive and interventional cardiology

Dörr

Stumpf²,

Spitzer³

et al. 2012

Herz

View full text Add to dashboard Cite

show abstract

Perkutane koronare Intervention versus Bypass-Operation bei Patienten mit Diabetes und koronarer Mehrgefäßerkrankung

Dörr

Stumpf

Dalibor

et al. 2014

Herz

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Is coronary revascularization required in a patient with chronic stable coronary artery disease or can optimized medical therapy (OMT) alone be a sufficient alternative? This question has been controversially discussed for non-diabetics as well as for diabetics since the COURAGE and BARI 2D trials. According to our present knowledge, a patient will benefit from coronary revascularization only when either a non-invasive test method, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial scintigraphy, stress echocardiography or stress nuclear magnetic resonance imaging, can detect relevant, objective evidence of ischemia >10% of the left ventricular myocardium or when a pathological fractional flow reserve (FFR) <0.80 can be measured in an invasive procedure for an angiographically detectable coronary stenosis. If similar relevant ischemia can be non-invasively or invasively objectified in a patient with chronic stable multivessel coronary artery disease, the often controversially discussed question arises particularly in diabetics whether a percutaneous coronary intervention (PCI) with implantation of drug-eluting stents or coronary artery bypass surgery should be favored. The FREEDOM study (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease), published in November 2012, was the first prospective randomized study to examine this issue in diabetic patients with multivessel coronary artery disease. Despite a higher rate of stroke in the surgical cohort, after an average follow-up time of 3.8 years a significant prognostic advantage in favor of bypass surgery was detected for a combined primary endpoint of all-cause mortality, nonfatal myocardial infarction and nonfatal stroke. Thus, in the new ESC guidelines on diabetes, pre-diabetes and cardiovascular diseases developed with the EASD of the European Society of Cardiology and published in 2013, coronary bypass surgery has a class I, level of evidence A recommendation for patients with diabetes mellitus, chronic stable multivessel coronary disease and a synergy between PCI with taxus and cardiac surgery (SYNTAX) score >22. The decision for or against a PCI/stent implantation or coronary bypass surgery in a diabetic patient with chronic stable multivessel coronary artery disease should therefore be made with the patient only after a detailed informed consent discussion and comprehensive explanation of both treatment options. In controversial cases, particularly with an equivocal SYNTAX score around 22, relevant comorbidities or anticipated method-specific complications, a one-stage ad hoc intervention during the diagnostic coronary angiography should be rejected in favor of a two-stage procedure with prior discussion of both treatment options in the heart team comprising noninvasive cardiologists, interventional cardiologists and cardiac surgeons.

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Outcomes of Coronary Revascularization (Percutaneous or Bypass) in Patients With Diabetes Mellitus and Multivessel Coronary Disease

Hee¹,

Mussap²,

Yang³

et al. 2012

The American Journal of Cardiology

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Bypasschirurgie versus perkutane koronare Intervention bei Patienten mit Diabetes mellitus

Cited by 3 publications

References 50 publications

Prevalence of undetected diabetes mellitus in invasive and interventional cardiology

Prevalence of undetected diabetes mellitus in invasive and interventional cardiology

Perkutane koronare Intervention versus Bypass-Operation bei Patienten mit Diabetes und koronarer Mehrgefäßerkrankung

Outcomes of Coronary Revascularization (Percutaneous or Bypass) in Patients With Diabetes Mellitus and Multivessel Coronary Disease

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