Influence of Diabetes Mellitus on Long-Term Outcomes of Patients With Unprotected Left Main Coronary Artery Disease Treated With Either Drug-Eluting Stents or Coronary Artery Bypass Grafting

Yu, Xianpeng; He, Jiarong; Luo, Yawei; Yuan, Fei; Song, Xiaoyan; Gao, Yunbo; Quan, Li; Huang, Fang-jiong; Gu, Chengxiong; Liu, Shuzheng; Chen, Fang

doi:10.1536/ihj.14-193

Cited by 13 publications

(20 citation statements)

References 27 publications

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“…No important differences was found in terms of other comorbidities between hypothyroid and non-hypothyroid patients. As suggested by Zindrou et al [ 7 ] and Park et al [ 8 ] , this metabolic disease does not determine the onset of other diseases, unlike what has been observed in diabetes and heart failure [ 12 , 13 , 20 ] .…”

Section: Discussionmentioning

confidence: 97%

Hypothyroidism is a Risk Factor for Atrial Fibrillation after Coronary Artery Bypass Graft

Jaimes

Torrado

Reyes

et al. 2017

Braz J Cardiovasc Surg

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IntroductionFew reports in the world have shown a differential effect of hypothyroidism in relation to morbidity and mortality following cardiac surgery.ObjectiveTo determine the association between preoperative hypothyroidism, composite and disaggregated outcomes of mortality and complications in patients undergoing first-time isolated myocardial revascularization surgery.MethodsHistorical cohort of patients undergoing myocardial revascularization between January 2008 and December 2014, with 626 patients included for evaluation of the composite and disaggregated outcomes of in-hospital mortality and complications (atrial fibrillation, surgical site infection and reoperation due to bleeding). A logistic regression model was used to determine the association between hypothyroidism and the onset of those outcomes.ResultsCohort of 1696 eligible patients for the study, with 1.8 mortality. Median age, female gender and prevalence of arterial hypertension were all significantly higher among hypothyroid patients. No differences were found in other preoperative or intraoperative characteristics. Hypothyroidism was associated with the presence of the composite outcome, RR 1.6 (1.04-2.4) and atrial fibrillation 1.9 (1.05-3.8). No association with mortality, infections or reoperation due to bleeding was found.ConclusionHypothyroidism is a disease that affects females predominantly and does not determine the presence of other comorbidities. Hypothyroidism is a risk factor for the onset of postoperative fibrillation in patients undergoing myocardial revascularization surgery. Postoperative care protocols focused on the prevention of these complications in this type of patients must be instituted.

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Section: Discussionmentioning

confidence: 97%

Hypothyroidism is a Risk Factor for Atrial Fibrillation after Coronary Artery Bypass Graft

Jaimes

Torrado

Reyes

et al. 2017

Braz J Cardiovasc Surg

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“…Some of them comparing outcomes after PCI with 2 nd DES suggest that DM no longer correlates with ISR [6, 7], whereas others confirm that DM is still a risk factor of TLR [8]. Therefore, some investigators have concluded that DM is no longer a predictor of ISR after DES implantation for specific populations, such as patients with vein graft lesions, simple lesions (ACC/AHA type A/B1 lesions) and unprotected left main [5, 9, 10]. This study suggests that in 2 nd generation DES era, DM is not an independent risk factor of MACE in patients accepting repeat DES implantation for DES-ISR.…”

Section: Discussionmentioning

confidence: 99%

“…However, in DES era some studies have suggested that DM has no longer correlated with ISR [6, 7], while others still identify DM as a predictor of TLR [8]. Overall it is likely that DM is not a predictor of ISR for vein grafts and simple lesions (ACC/AHA type A/B1 lesions) and unprotected left main coronary artery lesions [5, 9, 10]. …”

Section: Introductionmentioning

confidence: 99%

Effect of diabetes mellitus on long-term outcomes after repeat drug-eluting stent implantation for in-stent restenosis

Zhao

Zhu

Zhang

et al. 2017

BMC Cardiovasc Disord

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BackgroundWhether diabetes mellitus (DM) is a predictor of long-term adverse clinical outcomes after repeat drug eluting stent (DES) implantation for DES in-stent restenosis (ISR) remains controversial. We sought to evaluate the effect of DM on the long-term clinical outcomes in patients undergoing repeat DES implantation for DES-ISR lesions.MethodsIn the present study, 254 patients with DES-ISR were divided into DM or non-DM groups according to the presence or absence of DM. All patients received repeat 2nd generation DES implantation for DES-ISR. The occurrences of major adverse cardiac events (MACEs) over a 2-year follow-up period were compared between the two groups. MACEs were defined as cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). MACE free survival was investigated with Kaplan-Meier curve analysis. Cox regression analysis was used to identify factors associated with MACEs.ResultsBaseline clinical characteristics were similar between groups, except for the prevalence of early restenosis (lower) in the DM group. Differences in angiographic and procedural characteristics were not significant between groups. The rates of 2-year MACE (30.9 vs. 26.0%; P = 0.453) and TLR (24.7 vs. 19.7%; P = 0.411) were similar between groups. MACE-free survival and TLR-free survival were also similar between groups (P = 0.441 and P = 0.807). Subgroup analysis suggested a significant difference in the MACE (39.0 vs.15.3%, P < 0.001) and TLR occurrence (30.5 vs.8.2%, P < 0.001) and TLR-free survival (lower in early subgroup, P < 0.001) between early and late occurrence of ISR in the non-DM group of patients but not in the DM group. After adjustment for all significant clinical variables, Cox regression analysis indicated that DM was not associated with MACEs (hazard ratio [HR] 1.531, 95% confidence interval [CI] 0.882-2.658, P =0.130). Non-focal type ISR and early ISR were predictors of MACEs (HR 2.671, 95% CI 1.468-4.858,P = 0.001; HR 4.703, 95% CI 2.725-8.117, P < 0.001, respectively).ConclusionsPatients with DM have similar 2-year clinical outcomes to patients without DM when repeat 2nd generation DES was used for treatment of DES-ISR. DM is not the predictor of long-term prognosis in patients undergoing repeat 2nd generation DES for DES-ISR.

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“…Although short-term and long-term risk of mortality and major adverse cardiovascular and cerebrovascular events (MACCE) were comparable, constantly higher rate of repeat revascularization was concerned. [2][3][4][5] On the other hand, cardiovascular morbidity and mortality rates are markedly increased in patients with chronic kid-ney disease (CKD), 6) and the severity of renal function impairment significantly affected the incidence of MACCE in patients with ULMCAD and stable angina. 7) In patients with advanced CKD and CAD, CABG was suggested to be associated with lower risks of acute coronary syndrome, repeat revascularization, and better survival comparing with PCI regardless the severity of CAD.…”

mentioning

confidence: 99%

Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention for Left Main Coronary Artery Disease with Chronic Kidney Disease

Lin

Huang

et al. 2018

Int. Heart J.

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Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD). However, the optimal treatment for ULMCAD concomitant with chronic kidney disease (CKD) was rarely addressed. Herein, we compare the long-term outcomes of these patients treated with CABG or PCI.From January 2004 to December 2010, 185 patients with ULMCAD and CKD undergoing PCI (n = 84) or CABG (n = 101) were matched for the selection criteria. The primary end points included all-cause death, myocardial infarction (MI), stroke, repeat revascularization and major adverse cardiovascular and cerebrovascular event (MACCE).The mean age was 73.4 ± 10.3 years with male (84%) predominance. Baseline characteristics of both groups were similar, except that patients in CABG group were more frequently associated with significant stenosis of right coronary artery and triple vessel disease. Furthermore, most patients belonged to higher surgical risk population (EuroSCORE ≥ 6, PCI group: 80.9%, CABG group: 75.2%). After treatment, the 30-day mortality was 3.5% in PCI and 8.9% in CABG (P = 0.14). During the median follow-up of 3.5 years, the risk of MACCE (67% versus 55%, P = 0.048), MI (15.5% versus 6.9%, P = 0.024), and repeat revascularization (30.9% versus 7.9%, P < 0.001) was significantly higher in the PCI compared with CABG. There were no significant differences in long-term all-cause death, stroke, and impact on renal function.CABG was associated with significantly less long-term risk of MI and repeat revascularization in patients with ULMCAD and CKD.

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Influence of Diabetes Mellitus on Long-Term Outcomes of Patients With Unprotected Left Main Coronary Artery Disease Treated With Either Drug-Eluting Stents or Coronary Artery Bypass Grafting

Cited by 13 publications

References 27 publications

Hypothyroidism is a Risk Factor for Atrial Fibrillation after Coronary Artery Bypass Graft

Hypothyroidism is a Risk Factor for Atrial Fibrillation after Coronary Artery Bypass Graft

Effect of diabetes mellitus on long-term outcomes after repeat drug-eluting stent implantation for in-stent restenosis

Coronary Artery Bypass Surgery versus Percutaneous Coronary Intervention for Left Main Coronary Artery Disease with Chronic Kidney Disease

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