Comparison of Medium-Term Outcomes Obtained With Drug-Eluting Stents and Coronary Artery Bypass Grafts in an Unselected Population of Diabetic Patients With Multivessel Coronary Disease. Propensity Score Analysis

Domínguez-Franco, Antonio J.; Hernández-García, José M.; Alonso‐Briales, Juan H.; Linde-Estrella, Antonio L.; Pérez-González, Olga; Olalla-Mercadé, Eduardo; Teresa–Galván, Eduardo de

doi:10.1016/s1885-5857(09)71831-6

Cited by 14 publications

(21 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unlike TVR, stroke is relatively less frequent but a major safety end point with significant mortality and morbidity. [16][17][18] In the SYNTAX trial, of the patients who had a stroke and survived, 68% of the CABG patients versus 47% of the PCI patients had residual deficits. 10 This suggests that in survivors of stroke after CABG, there is a higher likelihood of persistence of neurological deficits and increased morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…6,8 Age, hypertension, diabetes mellitus, chronic renal failure, low ejection fraction, peripheral vascular disease, aortic arch atherosclerosis, carotid artery disease, prior stroke history, and perioperative atrial fibrillation are common denominators pertaining to stroke risk from either strategy. [17][18][19][20] Thrombo/ atheroembolism from aortic manipulation, intraoperative hypoperfusion, on pump procedures, duration of bypass, and requirement of blood transfusions are more specific to early stroke in patients undergoing CABG. 17,19 With improvement in surgical techniques, the temporal profile of stroke reveals an increased incidence in postoperative day 2, implying that inflammation and hypercoagulability may play a greater role.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Late Stroke: Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Multivessel Disease and Unprotected Left Main Disease

Athappan

Chacko

Patvardhan

et al. 2014

Stroke

View full text Add to dashboard Cite

Background and Purpose-Studies have suggested that the early excess risk of stroke in coronary artery bypass grafting (CABG) may be compensated for by a slow but progressive catch-up phenomenon in patients undergoing percutaneous coronary intervention (PCI). We therefore undertook this analysis to compare the temporal stroke risk between PCI and CABG in patients with unprotected left main stenosis and multivessel coronary artery disease. Methods-Studies of PCI versus CABG for unprotected left main stenosis and multivessel disease published between January 1994 (stent era) and July 2013 were identified using an electronic search and reviewed using meta-analytic techniques. Results-We selected 57 reports for the meta-analysis by applying the inclusion and exclusion criteria. The primary search terms used were CABG and PCI. For the Cochrane database the search terms were limited by the term clinical trial. Limiting the search parameters to the English language was applied subsequently. Citations were screened at the title and abstract level and retrieved as full reports if they were clinical studies, compared PCI with CABG, and provided information on the outcome of stroke. The full texts of all potential articles were reviewed in detail. The bibliography of retained studies was used to seek additional relevant studies. Inclusion CriteriaStudies were included if the following criteria applied: (1) comparative trials of CABG versus PCI with stent placement, (2) unprotected left main stenosis of >50% narrowing or multivessel disease, (3) a minimum of 30 patients, and (4) a minimum follow-up of 1 year. When 2 similar studies were reported from the same institution or author, the most recent publication was included in the analysis. Exclusion CriteriaStudies were excluded if any of the following criteria applied: (1) outcome of interest was not clearly reported or was impossible to extract or calculate from the published results, (2) <1-year follow-up, (3) included patients with ST-segment-elevation myocardial infarction, and (4) included patients with percutaneous transluminal coronary angioplasty without stents. Data ExtractionInformation collected included first author, year and journal of publication, study design, inclusion/exclusion criteria, definition of primary and secondary end points, number of subjects included, subjects undergoing PCI and CABG, percentage of drug-eluting stent used, study population demographics, number of diseased vessels, stenting technique, type of CABG (on pump versus off pump), left internal mammary artery graft used (single versus double), follow-up time period, rates of angiographic follow-up, antiplatelet regimen used, and primary and secondary outcomes. There was no disagreement between the 2 reviewers (G.A. and P.C.).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Late Stroke: Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Multivessel Disease and Unprotected Left Main Disease

Athappan

Chacko

Patvardhan

et al. 2014

Stroke

View full text Add to dashboard Cite

show abstract

“…We identified 19 eligible studies (4 randomized [19][20][21][22] and 15 nonrandomized [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]) ( Fig. 1) enrolling 5,805 patients in OCT subgroup (PCI-DES: 2,961; CABG: 2,844) and 3,060 in RCT subgroup (PCI-DES: 1,541; CABG: 1,519), respectively.…”

Section: Resultsmentioning

confidence: 99%

Comparison of bypass surgery and drug-eluting stenting in diabetic patients with left main and/or multivessel disease: A systematic review and meta-analysis of randomized and nonrandomized studies

et al. 2015

View full text Add to dashboard Cite

Background: With advances in theinterventional field, the choice between coronary artery bypass grafting (CABG) and percutaneous coronary intervention with drug-eluting stents (PCI-DES) for the diabetic subset with left main (LM) and/or multivessel disease (MVD CABG (11.7% DES vs. 9.1% CABG, RR 1.23, p = 0. 06). Patients after PCI-DES had higher prevalence of myocardial infarction (MI) when compared with CABG (8.5% DES vs. 4.6% CABG, RR 1.68, p = 0.003). PCI-DES patients were at substantially lower risk of stroke (2.0% DES vs. 3.9% CABG, RR 0.51, p < 0.00001), but at several-fold higher risk of repeat revascularization (19.0% DES vs. 6.3% CABG, RR 2.95, p < 0.00001). The OCT patients risked a lower mortality as compared to the RCT patients (9.6% OCTs vs. 11.9% RCTs, RR 0.81, p = 0.001 (OCTs). (Cardiol J 2015; 22, 2: 123-134)

show abstract

“…The remaining 19 publications from 16 studies were selected for final analysis (Fig. ; Tables ) . There were five publications from two studies at different follow‐up times.…”

Section: Resultsmentioning

confidence: 99%

“…1; Tables 1,2). [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] There were five publications from two studies at different follow-up times.…”

Section: Studies Includedmentioning

confidence: 99%

Coronary artery bypass grafting versus drug‐eluting stents in patients with severe coronary artery disease and diabetes mellitus: Systematic review and meta‐analysis 冠状动脉旁路移植术与药物洗脱支架治疗严重冠心病合并糖尿病的患者：系统评估和meta分析

Zhang

et al. 2014

Journal of Diabetes

View full text Add to dashboard Cite

Background: A comprehensive meta-analysis was performed to evaluate the comparative benefits of coronary artery bypass grafting (CABG) versus drugeluting stents (DES) in patients with diabetes mellitus and severe coronary artery disease (CAD). Methods: A comprehensive literature search of PubMed, Embase, and ScienceDirect was undertaken. References cited with the papers were also checked to identify relevant articles. Results: In all, four randomized controlled trials, two prospective registries, and 11 retrospective studies were identified for review. Pooled analysis demonstrated that DES was associated with lower all-cause mortality at Day 30. However, there was no significant difference between CABG and DES in mortality at 12 months and at maximum follow-up. Furthermore, DES was associated with lower overall and major adverse cardiac and cerebrovascular events (MACCE)-free survival, as well as a higher incidence of myocardial infarction and repeat revascularization. In contrast, CABG was associated with an increased risk of stroke. Conclusions: For patients with diabetes mellitus and severe CAD, CABG is superior to DES in that it significantly improves overall and MACCE-free survival and reduces the incidence of myocardial infarction and repeat revascularization in the long term, although it is associated with greater perioperative risk and a higher incidence of stroke. Therefore, CABG should remain the gold standard for these patients.

show abstract

Comparison of Medium-Term Outcomes Obtained With Drug-Eluting Stents and Coronary Artery Bypass Grafts in an Unselected Population of Diabetic Patients With Multivessel Coronary Disease. Propensity Score Analysis

Cited by 14 publications

References 31 publications

Late Stroke: Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Multivessel Disease and Unprotected Left Main Disease

Late Stroke: Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Multivessel Disease and Unprotected Left Main Disease

Comparison of bypass surgery and drug-eluting stenting in diabetic patients with left main and/or multivessel disease: A systematic review and meta-analysis of randomized and nonrandomized studies

Coronary artery bypass grafting versus drug‐eluting stents in patients with severe coronary artery disease and diabetes mellitus: Systematic review and meta‐analysis 冠状动脉旁路移植术与药物洗脱支架治疗严重冠心病合并糖尿病的患者：系统评估和meta分析

Contact Info

Product

Resources

About