Comparison of Coronary Bypass Surgery with Angioplasty in Patients with Multivessel Disease

Bourassa, Martial G.; Rl, Frye; Sb, King; Detre, Katherine; Alderman, E L; Andrews, Krintine E; Sopko, George

doi:10.1056/nejm199607253350401

Cited by 1,370 publications

(79 citation statements)

References 29 publications

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“…Although, contemporary population data demonstrates evidence of reduction in cardiovascular complications with risk factor control in patients with diabetes 5, 6, it is not known whether this translates to improvements following coronary revascularization as recent randomized control trials continue to show worst outcomes in diabetic patients with complex coronary artery disease when treated with PCI compared with coronary artery bypass graft (CABG) 7, 8, 9.…”

Section: Introductionmentioning

confidence: 99%

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Noman

Balasubramaniam

Alhous

et al. 2016

Cathet Cardio Intervent

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ObjectivesTo assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency).BackgroundDM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI.MethodsRetrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011.ResultsAbout 7,652 patients were nondiabetics (non‐DM), 1,116 had non‐insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi‐vessel coronary artery disease, renal impairment and non‐coronary vascular disease were more prevalent in DM patients. Overall 30‐day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30‐day mortality were 1.28 (0.81–2.03, P = 0.34) in NITDM and 2.82 (1.61–4.94, P < 0.001) in ITDM compared with non‐DM. During a median follow‐up period of 641 days, longer‐term post‐30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer‐term mortality were 1.15 (0.88–1.49, P = 0.31) in NITDM and 1.88 (1.38–2.55, P < 0.001) in ITDM compared with non‐DM group. Similar result was observed in all three different PCI settings.ConclusionIn the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin‐treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non‐diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Noman

Balasubramaniam

Alhous

et al. 2016

Cathet Cardio Intervent

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“…However, advances in the percutaneous therapies including drug‐eluting stents (DES), and newer antithrombotic and antiplatelet regimens with aggressive medical therapy have led to marked improvement in outcomes following nonsurgical treatment of CAD. In addition, there have been considerable improvements in the surgical techniques including greater use of arterial grafts, greater use of off‐pump CABG, along with better postoperative care, which has antiquated the bulk of surgical outcomes data published earlier 55, 56. As the PCI technology continues to evolve and the surgical outcomes improve, we are more often than not faced with the ultimate question “What is the best revascularization strategy for patients with complex multivessel CAD?” (Figure 6).…”

Section: Lessons Learned From Complex Percutaneous Coronary Interventmentioning

confidence: 99%

Choice and Selection of Treatment Modalities for Cardiac Patients: An Interventional Cardiology Perspective

Agarwal

Tuzcu

Kapadia

2015

JAHA

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“…Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) for the treatment of multivessel coronary artery disease were compared in large randomized trials in the early 1990s [1, 2]. Although immediate results were comparable, CABG proved to be superior since the rate of major cardiac events at the 6- and 12-month follow-up was higher after PTCA, mainly due to restenosis [3].…”

Section: Introductionmentioning

confidence: 99%

Angiographic Outcome in Multivessel Disease (GABI II Study) Using New Coronary Device Interventions and Comparison with GABI I Trial Results

Dietz¹,

Baldus

Rupprecht

et al. 2004

Cardiology

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Percutaneous coronary interventions using stents were investigated in patients with multivessel disease. Acute and long-term results were compared with those of the German Angioplasty Bypass Surgery Investigation trial in a prospective multicenter study. The study included 134 patients in whom 277 lesions were treated. Angiographic success and procedural success were achieved in 268 of 277 lesions (97%) and 118 of 134 patients (88%), respectively. Control angiography performed in 90 of 118 eligible patients (76%) exhibited restenosis in 43 of 182 lesions (24%). Multivariate regression analysis found that a diffuse lesion, the lesion and stent length, and the final luminal diameter were predictive for restenosis. Thus, immediate and long-term results of multivessel coronary intervention utilizing stents were improved compared to percutaneous transluminal coronary angioplasty of multivessel lesions. However, there is still need for improvement of long-term results, especially in particular lesion subgroups.

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Comparison of Coronary Bypass Surgery with Angioplasty in Patients with Multivessel Disease

Cited by 1,370 publications

References 29 publications

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Choice and Selection of Treatment Modalities for Cardiac Patients: An Interventional Cardiology Perspective

Angiographic Outcome in Multivessel Disease (GABI II Study) Using New Coronary Device Interventions and Comparison with GABI I Trial Results

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