Percutaneous coronary interventions in diabetic patients: the impact of complete revascularization on long-term prognosis

Nikolsky, Evgenia; Patil, Chandrashekhar; Roguin, Ariel; Petcherski, Sirouch; Kapeliovich, Michael; Linn, Shai; Boulos, Monther; Grenadier, Ehud; Markiewicz, Walter

doi:10.1016/s0735-1097(02)80203-0

Cited by 14 publications

(18 citation statements)

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“…A study of patients with multivessel CAD and diabetes undergoing PCI in Israel confirmed that completeness of revascularization had an independent, positive impact on 5-year survival and survival free of MI. 21 One major advantage of the BARI 2D design is that it permitted investigators to select the mode of revascularization that was considered to be best suited for each patient. This undoubtedly resulted in a lower likelihood of incomplete revascularization in the patients undergoing PCI.…”

Section: Discussionmentioning

confidence: 99%

Impact of Completeness of Revascularization on Long-Term Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus

Schwartz

Bertolet

Feit

et al. 2012

Circ: Cardiovascular Interventions

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Background-Patients with diabetes have more extensive coronary disease than those without diabetes, resulting in more challenging percutaneous coronary intervention or surgical (coronary artery bypass graft) revascularization and more residual jeopardized myocardium. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial provided an opportunity to examine the long-term clinical impact of completeness of revascularization in patients with diabetes. Methods and Results-This is a post hoc, nonrandomized analysis of the completeness of revascularization in 751 patients who were randomly assigned to early revascularization, of whom 264 underwent coronary artery bypass graft surgery and 487 underwent percutaneous coronary intervention. The completeness of revascularization was determined by the residual postprocedure myocardial jeopardy index (RMJI). RMJI is a ratio of the number of myocardial territories supplied by a significantly diseased epicardial coronary artery or branch that was not successfully revascularized, divided by the total number of myocardial territories. Mean follow-up for mortality was 5.3 years. Complete revascularization (RMJIϭ0) was achieved in 37.9% of patients, mildly incomplete revascularization (RMJI Ͼ0Յ33) in 46.6%, and moderately to severely incomplete revascularization (RMJI Ͼ33) in 15.4%. Adjusted event-free survival was higher in patients with more complete revascularization (hazard ratio, 1.14; Pϭ0.0018). Conclusions-Patients

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Section: Discussionmentioning

confidence: 99%

Impact of Completeness of Revascularization on Long-Term Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus

Schwartz

Bertolet

Feit

et al. 2012

Circ: Cardiovascular Interventions

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“…[5][6][7][8][9][10][11][12][13] Our preliminary data suggest potential for larger comparative studies of CMR-based functional assessment with these existing anatomic scores. This could potentially result in a more accurate risk prediction in the individual patient after revascularization.…”

Section: Discussionmentioning

confidence: 79%

“…[5][6][7][8][9][10][11][12][13] Insights from physiological assessment using the pressure wire to measure fractional flow reserve have confirmed the limitation of angiography to assess the functional significance of coronary stenosis. 14 Because the functional consequences of revascularization may not correlate precisely with angiographic appearances, a potential limitation of these previous studies examining completeness of revascularization is their reliance on angiographic measures.…”

Section: Circ Cardiovasc Intervmentioning

confidence: 93%

Residual Ischemia After Revascularization in Multivessel Coronary Artery Disease

Arnold

Karamitsos

Gaal

et al. 2013

Circ: Cardiovascular Interventions

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Background-Revascularization strategies for multivessel coronary artery disease include percutaneous coronary intervention and coronary artery bypass grafting. In this study, we compared the completeness of revascularization as assessed by coronary angiography and by quantitative serial perfusion imaging using cardiovascular magnetic resonance. Methods and Results-Patients with multivessel coronary disease were recruited into a randomized trial of treatment with either coronary artery bypass grafting or percutaneous coronary intervention. Angiographic disease burden was determined by the Bypass Angioplasty Revascularization Investigation (BARI) myocardial jeopardy index. Cardiovascular magnetic resonance first-pass perfusion imaging was performed before and 5 to 6 months after revascularization. Using modelindependent deconvolution, hyperemic myocardial blood flow was evaluated, and ischemic burden was quantified. Sixtyseven patients completed follow-up (33 coronary artery bypass grafting and 34 percutaneous coronary intervention

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“…One-stage multivessel PCI is often tolerated well by stable patients, but may be performed over multiple sessions due to the technical considerations mentioned below. The strategy of staging multivessel PCI appears to be safe [79].…”

Section: Acute Coronary Syndromes (Unstable Angina/ Non-stemi)mentioning

confidence: 99%

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Blankenship

Moussa

Chambers

et al. 2011

Cathet Cardio Intervent

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Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI [1]. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article [4]. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable [5]. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed [6]. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.V C 2011 Wiley Periodicals, Inc.

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Percutaneous coronary interventions in diabetic patients: the impact of complete revascularization on long-term prognosis

Cited by 14 publications

References 0 publications

Impact of Completeness of Revascularization on Long-Term Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus

Impact of Completeness of Revascularization on Long-Term Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus

Residual Ischemia After Revascularization in Multivessel Coronary Artery Disease

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

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