Percutaneous Coronary Intervention Versus Coronary Bypass Surgery in United States Veterans With Diabetes

Kamalesh, Masoor; Sharp, T. G.; Tang, Xiaofang; Shunk, Kendrick A.; Ward, Herbert B.; Walsh, James P.; King, Spencer B.; Colling, Cindy; Möritz, Thomas; Stroupe, Kevin T.; Reda, Domenic J.

doi:10.1016/j.jacc.2012.11.044

Cited by 145 publications

(87 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar results were observed in a smaller randomised trial of Veterans (VA CARDS) with diabetes and multivessel CAD, which was terminated early due to significantly higher event rates in the group randomised to PCI. 19 Although the FREEDOM and Veterans Administration Coronary Artery Revascularization in Diabetes (VA CARDS) trials provide compelling evidence for surgical revascularisation over PCI among diabetic patients with multivessel CAD, several limitations of the study populations should be considered. First, the majority of patients in the trials were low-risk for surgery and had preserved ejection fraction; whether these findings apply to patients at higher surgical risk remains uncertain.…”

Section: Methods Of Revascularisationmentioning

confidence: 99%

Determining the Most Appropriate Mode of Coronary Artery Revascularisation in Patients With Diabetes

Armstrong

Waldo

2016

Interventional Cardiology Review

View full text Add to dashboard Cite

CoronaryPatients with diabetes mellitus (DM) have an increased prevalence of coronary artery disease (CAD) and are more likely to require coronary revascularisation than patients without DM. 1 Similar to the general population, CAD remains the most frequent cause of death among patients with DM. 2 As the prevalence of DM continues to rise worldwide, the appropriate management and method of revascularisation for diabetic patients will become an increasingly important clinical decision point. In this review, we discuss current data regarding the indications and optimal method of coronary revascularisation among patients with DM. Decision to Perform RevascularisationAs with the general population, patients with DM and CAD may present with asymptomatic ischaemia, stable angina or acute coronary syndromes. The clinical presentation and severity of symptoms significantly influences the decision to perform coronary artery revascularisation, as well as the relative timing of such a procedure.Although patients with DM have a higher prevalence of CAD, the majority of patients are asymptomatic before presenting with a myocardial infarction or other cardiovascular event. 3 Numerous studies have therefore investigated the use of routine screening for CAD among diabetic patients that do not have overt symptoms. The Detection of Ischaemia in Asymptomatic Diabetics (DIAD) study investigated routine screening for coronary ischaemia using myocardial perfusion imaging among asymptomatic diabetic patients. 4 During a mean follow-up of 4.8 years, the overall cardiac event rate was only 2.9 % with an event rate of 2.7 % in the screened group and 3.0 % in the unscreened group. The overall rate of revascularisation was also low at 5.5 % in the screened group and 7.8 % in the unscreened group. Similarly, the Screening For Together these two large randomised trials do not support a strategy of routine testing for CAD among asymptomatic diabetic patients.Among diabetic patients with symptomatic stable CAD, the decision to pursue revascularisation with either a percutaneous or surgical approach was studied in the Bypass Angioplasty Revascularisation Investigation in Type 2 Diabetes (BARI 2D) study. 6 In that trial diabetic patients with stable CAD were randomised to either optimal medical therapy with immediate percutaneous or surgical revascularisation at the discretion of the investigator or optimal medical therapy alone.At 5 years there was no difference in overall mortality between the two groups, although the rate of subsequent revascularisation in the medical therapy group was 38 % at 5 years. These results suggest that immediate revascularisation is not necessary among patients with DM and stable CAD in the absence of severe anginal symptoms, while recognising that a significant percentage of patients will eventually require revascularisation due to worsening of their symptoms. AbstractObstructive coronary artery disease is a common cause of morbidity and mortality among patients with diabetes mellitus (DM). Previous research has d...

show abstract

Section: Methods Of Revascularisationmentioning

confidence: 99%

Determining the Most Appropriate Mode of Coronary Artery Revascularisation in Patients With Diabetes

Armstrong

Waldo

2016

Interventional Cardiology Review

View full text Add to dashboard Cite

show abstract

“…Landmark trials include the Bypass Angioplasty Revascularization Investigation (BARI) trial, 60 the Arterial Revascularization Therapies (ARTS) randomized trial, 61 the Stent or Surgery (SoS) trial, 62 the Medicine, Angioplasty, or Surgery Study (MASS II), 63 the SYNTAX trial, 64 the Coronary Artery Revascularisation in Diabetes (CARDia) trial, 65 Veterans Affairs Coronary Artery Revascularization in Diabetes Study (VA CARDS), 66 and the Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) trial. 67 The first of these trials began in the balloon angioplasty era; only SYNTAX, CARDia, and FREEDOM include DES era data.…”

Section: Multivessel Diseasementioning

confidence: 99%

“…Authors acknowledged that CARDia was underpowered. 65 Also underpowered was the VA CARDS, 66 which was a small study (n=198) published within months of the larger FREEDOM trial. This multicenter randomized trial had significant problem with recruitment, screening 6,678 but including only 3% of those screened.…”

Section: Multivessel Disease In Patients With Diabetesmentioning

confidence: 99%

“…It should be noted that most landmark trials comparing CABG to PCI enrolled patients before second-generation stents were available, and only two trials included any patients treated with second-generation DES. 48,49 Indirect comparison using meta-analysis suggests potential equivalency between PCI with second-generation DES and CABG, but randomized controlled trials (RCTs) are not available. 52 demonstrated significant benefit in the combined endpoint, and notably, an overall mortality benefit, with ticagrelor treatment vs clopidogrel in acute coronary syndrome (ACS) patients.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

Burgess¹,

Edmond²,

Juergens³

et al. 2015

RRCC

View full text Add to dashboard Cite

Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI) has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG) and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the patients with low Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac surgery score, rates of revascularization were significantly lower with CABG. The new 2014 European Society of Cardiology guidelines also reflect this. Conclusion:The field of coronary revascularization is complex and constantly evolving. The best revascularization strategy for an individual patient must take into account clinical presentation, comorbidities, the extent and complexity of the coronary artery disease, and data from trials reflecting contemporary practice.

show abstract

“…However, the advances in the interventional field, especially the advent and development of drug-eluting stents (DES), which significantly reduced restenosis and the need for subsequent repeat revascularizations as compared with bare metal stents (BMS), have largely cut back one of the major limitations of percutaneous coronary interventions (PCI) [10][11][12][13][14][15][16][17][18]. Several randomized controlled trials (RCTs), exclusively comparing CABG surgery and PCI with DES (PCI-DES) for the diabetic subset with LM and/or MVD [19][20][21][22], have reported medium-and long--term outcomes, but given high-selected patients in the RCTs, their applicability to the general population is unknown. The observational controlled trial (OCTs), unlike the RCTs, can reflect daily clinical practice in the real world.…”

Section: Introductionmentioning

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

Percutaneous Coronary Intervention Versus Coronary Bypass Surgery in United States Veterans With Diabetes

Cited by 145 publications

References 18 publications

Determining the Most Appropriate Mode of Coronary Artery Revascularisation in Patients With Diabetes

Determining the Most Appropriate Mode of Coronary Artery Revascularisation in Patients With Diabetes

Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

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

Contact Info

Product

Resources

About