Surgical Versus Percutaneous Coronary Revascularization in Patients With Diabetes and Acute Coronary Syndromes

Ramanathan, Krishnan; Abel, James G.; Park, Julie E.; Fung, Anthony; Mathew, Verghese; Taylor, Carolyn; Mancini, G.B. John; Gao, Min; Ding, Lillian; Verma, Subodh; Humphries, Karin H.; Farkouh, Michael E.

doi:10.1016/j.jacc.2017.10.029

Cited by 95 publications

(68 citation statements)

References 15 publications

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“…196 Consequently, overall current evidence continues to favour CABG as the revascularization modality of choice for patients with diabetes and multivessel disease. When patients present with a comorbidity that increases surgical risk, the choice of revascularization method is best decided by multidisciplinary individualized risk assessment.…”

Section: Meta-analysis Of Coronary Artery Bypass Grafting Vs Percutamentioning

confidence: 99%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

5,059

2,078

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Section: Meta-analysis Of Coronary Artery Bypass Grafting Vs Percutamentioning

confidence: 99%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

5,059

2,078

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“…4 In most clinical trials, diabetic patients account for about 1/5 to 1/3 hospitalized patients with ACS. [5][6][7] According to previous studies, DM is a strong predictor of long-term ischemic events in patients with ACS with or without PCI, 8,9 and it is also an independent predictor of bleeding events in patients who received antithrombotic therapy. 10 Optimal antiplatelet regimens for diabetic patients have been studied in several randomized trials and post hoc analyses.…”

Section: Introductionmentioning

confidence: 97%

“…Diabetes mellitus (DM) is a common comorbidity in patients with coronary artery disease (CAD) . In most clinical trials, diabetic patients account for about 1/5 to 1/3 hospitalized patients with ACS . According to previous studies, DM is a strong predictor of long‐term ischemic events in patients with ACS with or without PCI, and it is also an independent predictor of bleeding events in patients who received antithrombotic therapy .…”

Section: Introductionmentioning

confidence: 99%

Impact of dual antiplatelet therapy duration on 1‐year clinical outcomes in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention: Insights from the real‐world OPT‐CAD study

Qiu

et al. 2019

Cathet Cardio Intervent

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Objectives To investigate the optimal dual antiplatelet therapy (DAPT) duration for diabetic patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Background Diabetic patients are at high risk for ischemic and bleeding events when treated with antithrombotic agents after an ACS episode. Methods This post hoc study analyzed DAPT duration and clinical outcomes in diabetic patients with ACS who underwent PCI in the Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT‐CAD) registry. The primary outcome was patient‐oriented composite endpoints (PoCE) at 12 months; it was defined as a composite of all‐cause mortality, all myocardial infarction (MI), stroke, or any revascularization. The safety outcome was bleeding events. Results In total, 1,773 diabetic patients with ACS were enrolled and treated with PCI in the OPT‐CAD study. Premature DAPT discontinuation before 12 months was an independent PoCE predictor in diabetic patients (hazard ratio = 1.33, 95% confidence interval: 1.02–1.74, p = .006). It was associated with a significantly higher risk of PoCE (17.3 vs. 11.2%, p = .014) in diabetic patients with high risk factors (age ≥ 65 years or history of cardiovascular events including MI, stroke, or peripheral artery disease), but this association was not observed in those without high risk factors (10.4 vs. 9.1, p = .554). No excess bleeding risk was found in patients who received 12‐month DAPT compared with those who discontinued DAPT prematurely. Conclusions Premature DAPT discontinuation before 12 months was associated with increased risk of clinical events in diabetic patients with ACS after PCI, particularly in those with high‐risk profiles.

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“…A large, observational, registry-based analysis combined all revascularization procedures performed in the population with DM and MVD in the province of British Columbia, Canada, from 2007 to 2014 (32). A total of 3,017 procedures were performed after an ACS (1,966 PCIs and 1,051 CABGs).…”

Section: Diabetes and Acute Coronary Syndromesmentioning

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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Surgical Versus Percutaneous Coronary Revascularization in Patients With Diabetes and Acute Coronary Syndromes

Abstract: In diabetic patients with MV-CAD, CABG was associated with a lower rate of long-term MACCE relative to PCI for both ACS and SIHD. A well-powered randomized trial of CABG versus PCI in the ACS population is warranted because these patients have been largely excluded from prior trials.

Cited by 95 publications

References 15 publications

2018 ESC/EACTS Guidelines on myocardial revascularization

2018 ESC/EACTS Guidelines on myocardial revascularization

Impact of dual antiplatelet therapy duration on 1‐year clinical outcomes in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention: Insights from the real‐world OPT‐CAD study

Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus

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