Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization

Head, Stuart J.; Milojevic, Milan; Daemen, Joost; Ahn, Jung Min; Boersma, Eric; Christiansen, Evald Høj; Domanski, Michael J.; Farkouh, Michael E.; Flather, Marcus; Fuster, Valentín; Hlatky, Mark A.; Holm, Niels Ramsing; Hueb, Whady; Kamalesh, Masoor; Kim, Young Hak; Mäkikallio, Timo H.; Mohr, Friedrich W.; Papageorgiou, Grigorios; Park, Seung Jung; Rodríguez, Alfredo E.; Sabik, Joseph F.; Stables, Rodney H; Stone, Gregg W.; Serruys, Patrick W.; Kappetein, Arie Pieter

doi:10.1016/j.jacc.2018.04.071

Cited by 107 publications

(65 citation statements)

References 33 publications

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“…While some other studies showed that CABG resulted in significantly higher rates of stroke than PCI for LM or multivessel disease [3], we found that the difference in rates was indistinctive. e mechanisms underlying the increased risk of stroke with CABG are likely multifactorial.…”

Section: Discussioncontrasting

confidence: 97%

“…Coronary artery bypass graft (CABG), as an effective treatment for CAD, has been introduced for more than 50 years, and it is currently the preferred modality for treating complex CAD [1,2]. However, over the last twenty years, there have been significant advances in percutaneous coronary intervention (PCI) from the era of balloon angioplasty and subsequent bare-metal stents to drug-eluting stents (DESs) [3]. With improving technology and techniques for PCI, such as adjunctive antithrombotic drugs, periprocedural management, and the experience of interventional cardiologists, research has focused increasingly on more complex diseases, such as LM disease and multivessel disease.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Second Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease

Chen

Zhang

Yan

et al. 2020

Journal of Interventional Cardiology

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Background. Many studies have compared the outcomes of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for complex coronary artery disease (CAD). However, no trials have focused on young patients (<45 years) with complex CAD. We conducted a retrospective evaluation to compare the outcomes of a second-generation drug-eluting stent (DES) and CABG in young patients with LM or three-vessel disease. Methods. In young patients with complex CAD who underwent PCI or CABG, a Kaplan-Meier analysis and Cox regression before and after propensity score matching were used to compare major adverse cardiac and cerebrovascular events (MACCE), including myocardial infarction (MI), stroke, death, and repeat revascularization. Results. During follow-up, MACCE occurred in 20.5% of patients in the PCI group and 8.6% of patients in the CABG group (hazard ratio (HR): 3.263, 95% confidence interval (CI): 1.379 to 7.722, p=0.007). Repeat revascularization occurred more frequently in the PCI group (18.9% vs. 3.7%, respectively, HR: 6.968, 95% CI: 2.036 to 23.842, p=0.002). There were no significant differences in the other endpoints. After propensity score matching, no conclusions were modified. Conclusions. In young patients with LM or three-vessel disease, PCI showed a higher incidence of MACCE, which was mainly driven by repeat revascularization. However, this did not translate into hard endpoint differences. Therefore, PCI is an alternative treatment to CABG in young patients with complex CAD.

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Section: Discussioncontrasting

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Second Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease

Chen

Zhang

Yan

et al. 2020

Journal of Interventional Cardiology

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“…313 After 30 days, stroke rates between revascularization techniques were similar in a recent individual patient data meta-analysis of 11 randomized trials. 313 Ischaemic stroke after CABG is multifactorial: thrombo-embolism from the aorta, its branches, or the heart; atrial arrhythmias; inflammatory pro-thrombogenic milieu; lower levels of antiplatelet therapy perioperatively; and haemodynamic instability. However, the most consistent predictor of perioperative stroke is previous stroke or TIA.…”

Section: Prevention Of Stroke Associated With Carotid Artery Disease mentioning

confidence: 91%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

5,011

2,078

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“…A landmark analysis of the whole population (with or without DM) suggested that the increased risk of stroke after CABG is more pronounced in the first 30 days after the procedure. Stroke rates from day 31 to 5 years were comparable between PCI and CABG groups (15). Arterial conduits have better long-term patency when compared with venous grafts, but the use of bilateral internal mammary artery grafts in patients with DM is still debatable, given the concerns of sternal wound infection (16).…”

Section: Multivessel Diseasementioning

confidence: 96%

“…When compared with CABG, PCI was associated with a higher likelihood of 5-year all-cause mortality in patients with DM and MVD (n¼3,266 patients; hazard ratio [HR], 1.48; 95% CI, 1.19 to 1.84; p¼0.0004) (14). Conversely, PCI was associated with significantly lower 5-year stroke rates compared with CABG, especially in patients with DM (HR, 0.52; 95% CI, 0.37 to 0.75; p<0.001; p¼0.004 for interaction) (15). A landmark analysis of the whole population (with or without DM) suggested that the increased risk of stroke after CABG is more pronounced in the first 30 days after the procedure.…”

Section: Multivessel Diseasementioning

confidence: 99%

Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus

Tavares

Farkouh

2020

Canadian Journal of Diabetes

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Key MessagesPatients with diabetes mellitus more frequently have diffuse and multivessel coronary artery disease. Coronary artery bypass surgery is the preferred revascularization strategy in most patients with diabetes. Special attention should be given to optimal control of risk factors in the postrevascularization setting. a b s t r a c t Patients with diabetes mellitus (DM) are at increased risk for developing coronary artery disease. Choosing the optimal revascularization strategy, such as coronary artery bypass grafting or percutaneous coronary intervention (PCI), may be difficult in this population. A large body of evidence suggests that, for patients with DM and stable multivessel ischemic heart disease, coronary artery bypass grafting is usually superior to PCI, leading to lower rates of all-cause mortality, myocardial infarction and repeat revascularization in the long term. In patients with less complex coronary anatomy (2-or single-vessel disease, especially without involvement of the proximal left anterior descendent artery), PCI may be a viable option. Because these anatomic patterns are less frequent in patients with DM, there is less evidence to guide revascularization in these cases. Patients with DM and left main disease and those in the acute coronary syndrome setting are also underrepresented in randomized trials, and the best revascularization strategy for these patients is not clear. Once the revascularization procedure is performed, patients should be kept engaged in controlling the risk factors for progression of cardiovascular disease. Avoidance of smoking, control of cholesterol, blood pressure and glycemic levels; regular practice of physical activity of at least moderate intensity; and a balanced diet are of key importance in the postrevascularization period. In this study, we review the current literature in the management of patients with DM and coronary artery disease undergoing a revascularization procedure.Ó 2019 Canadian Diabetes Association. Mots clés : maladie cardiovasculaire pontage aortocoronarien diabète intervention coronarienne percutanée r é s u m é Les patients atteints de diabète sucré (DS) sont exposés à un risque accru de coronaropathie. Le choix d'une stratégie de revascularisation optimale telle que le pontage aortocoronarien ou l'intervention coronarienne percutanée (ICP) peut être difficile pour cette population. De nombreuses données probantes montrent que chez les patients atteints de DS et d'une cardiopathie ischémique multitronculaire stable le pontage aortocoronarien offre généralement des résultats supérieurs à l'ICP, puisqu'il entraîne une diminution des taux de mortalité toutes causes confondues et de revascularisation répétée à long terme. Chez les patients qui ont une anatomie des artères coronaires moins complexe (maladie monotronculaire ou bitronculaire, particulièrement sans la contribution de l'artère interventriculaire Can J Diabetes 44 (2020) 78e85antérieure proximale), l'ICP peut être une option viable. Comme ces anatomies sont moins fréquentes c...

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Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization

Cited by 107 publications

References 33 publications

Second Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease

Second Generation Drug-Eluting Stent Implantation versus Coronary Artery Bypass Grafting in the Treatment of Young Patients with Left Main and/or Multivessel Coronary Disease

2018 ESC/EACTS Guidelines on myocardial revascularization

Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus

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