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Long term outcomes of percutaneous coronary intervention vs coronary artery bypass grafting in patients with diabetes mellitus with multi vessels diseases: A meta-analysis. IJC HEART & VASCULATURE 2023; 46:101185. [DOI: 10.1016/j.ijcha.2023.101185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/27/2023]
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Xin X, Wang X, Dong X, Fan Y, Shao W, Lu X, Xiao P. Efficacy and safety of drug-eluting stenting compared with bypass grafting in diabetic patients with multivessel and/or left main coronary artery disease. Sci Rep 2019; 9:7268. [PMID: 31086198 PMCID: PMC6513866 DOI: 10.1038/s41598-019-43681-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/25/2019] [Indexed: 11/09/2022] Open
Abstract
Although percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) and bypass grafting are generally believed to be superior revascularization strategies in patients with coronary artery disease (CAD), the optimal strategy for diabetic patients is still controversial. This meta-analysis was performed to compare two methods of revascularization for patients with diabetes mellitus with left main coronary artery lesions or disease in multiple coronary arteries. Compared with the coronary artery bypass grafting (CABG) group, those receiving PCI-DES showed a greater risk of major adverse cardiovascular events (MACEs) (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.01-1.25, P = 0.03), major adverse cardiac and cerebrovascular events (MACCEs) (HR: 1.85, 95% CI: 1.58-2.16; P < 0.001), stroke (HR: 1.15, 95% CI: 1.02-1.29, P = 0.02), myocardial infarction (MI) (HR: 1.48, 95% CI: 1.04-2.09, P = 0.03), and repeat revascularization (HR: 3.23, 95% CI: 1.37-7.59, P = 0.007). CABG for diabetic patients with multivessel and/or left main CAD was superior to PCI-DES with regard to MACEs, MACCEs, MI, repeat revascularization and stroke, but there was no clear difference in all-cause mortality.
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Affiliation(s)
- Xiaojun Xin
- Department of Cardiology, The Affiliated Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangming Wang
- Department of Geriatric Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuesi Dong
- Department of Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Yuanming Fan
- Clinical Metabolomics Center, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Wei Shao
- Department of Cardiology, The Affiliated Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Lu
- Department of Cardiology, The Affiliated Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
| | - Pingxi Xiao
- Department of Cardiology, The Affiliated Sir Run Run Hospital of Nanjing Medical University, Nanjing, China.
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Schwann TA. The Surgical Treatment of Coronary Artery Occlusive Disease: Modern Treatment Strategies for an Age Old Problem. Surg Clin North Am 2017; 97:835-865. [PMID: 28728719 DOI: 10.1016/j.suc.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary artery disease remains a formidable challenge to clinicians. Percutaneous interventions and surgical techniques for myocardial revascularization continue to improve. Concurrently, in light of emerging data, multiple practice guidelines have been published guiding clinicians in their therapeutic decisions. The multidisciplinary Heart Team concept needs to be embraced by all cardiovascular providers to optimize patient outcomes.
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Affiliation(s)
- Thomas A Schwann
- Department of Surgery, University of Toledo College of Medicine & Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA.
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Chung WJ, Chen CY, Lee FY, Wu CC, Hsueh SK, Lin CJ, Hang CL, Wu CJ, Cheng CI. Validation of Scoring Systems That Predict Outcomes in Patients With Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting Surgery. Medicine (Baltimore) 2015; 94:e927. [PMID: 26061316 PMCID: PMC4616463 DOI: 10.1097/md.0000000000000927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Several risk stratification scores, based on angiographic or clinical parameters, have been developed to evaluate outcomes in patients with left main coronary artery disease (LMCAD) who undergo coronary artery bypass grafting (CABG). This study aims to validate the predictive ability of different risk scoring systems with regard to long-term outcomes after CABG. This single-center study retrospectively re-evaluated the Synergy Between PCI with TAXUS and Cardiac Surgery (SYNTAX) score; EuroSCORE; age, creatinine, and ejection fraction (ACEF) score; modified ACEF score; clinical SYNTAX; logistic clinical SYNTAX score (logistic CSS); and Parsonnet scores for 305 patients with LMCAD who underwent CABG. The endpoints were 5-year rate of all-cause death and major adverse cardio-cerebral events (MACCEs), including cardiovascular (CV) death, myocardial infarction (MI), and stroke and target vessel revascularization (TVR). Compared with the SYNTAX score, other scores were significantly higher in discriminative ability for all-cause death (SYNTAX vs others: P < 0.01). The EuroSCORE ≥6 showed significant outcome difference on all-cause death, CV death, MI, and MACCE (P < .01). Multivariate analysis indicated the SYNTAX score was a non-significant predictor for different outcomes. Adjusted multivariate analysis revealed that the EuroSCORE was the strongest predictor of all-cause death (hazard ratio[HR]: 1.17; P < 0.001), CV death (HR: 1.16; P < 0.001), and MACCE (HR: 1.09; P = 0.01). The ACEF score and logistic CSS were predictive factors for TVR (HR: 0.25, P = 0.03; HR: 0.85, P = 0.01). The EuroSCORE scoring system most accurately predicts all-cause death, CV death, and MACCE over 5 years, whereas low ACEF score and logistic CSS are independently associated with TVR over the 5-year period following CABG in patients with LMCAD undergoing CABG.
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Affiliation(s)
- Wen-Jung Chung
- From the Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital (W-JC, S-KH, C-JL, C-LH, C-JW, C-IC); Chang Gung University College of Medicine (W-JC, F-YL, C-CW, S-KH, C-JL, C-LH, C-JW, C-IC); Department of Pharmacy, Kaohsiung Medical University Hospital, School of Pharmacy, Master Program in Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung (C-YC); and Department of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C. (F-YL, C-CW)
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Wu YC, Su TW, Zhang JF, Shen WF, Ning G, Kong Y. Coronary artery bypass grafting versus drug-eluting stents in patients with severe coronary artery disease and diabetes mellitus: systematic review and meta-analysis. J Diabetes 2015; 7:192-201. [PMID: 24893748 DOI: 10.1111/1753-0407.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND A comprehensive meta-analysis was performed to evaluate the comparative benefits of coronary artery bypass grafting (CABG) versus drug-eluting stents (DES) in patients with diabetes mellitus and severe coronary artery disease (CAD). METHODS A comprehensive literature search of PubMed, Embase, and ScienceDirect was undertaken. References cited with the papers were also checked to identify relevant articles. RESULTS In all, four randomized controlled trials, two prospective registries, and 11 retrospective studies were identified for review. Pooled analysis demonstrated that DES was associated with lower all-cause mortality at Day 30. However, there was no significant difference between CABG and DES in mortality at 12 months and at maximum follow-up. Furthermore, DES was associated with lower overall and major adverse cardiac and cerebrovascular events (MACCE)-free survival, as well as a higher incidence of myocardial infarction and repeat revascularization. In contrast, CABG was associated with an increased risk of stroke. CONCLUSIONS For patients with diabetes mellitus and severe CAD, CABG is superior to DES in that it significantly improves overall and MACCE-free survival and reduces the incidence of myocardial infarction and repeat revascularization in the long term, although it is associated with greater perioperative risk and a higher incidence of stroke. Therefore, CABG should remain the gold standard for these patients.
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Affiliation(s)
- Yi-Cheng Wu
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Coronary Artery Surgery Versus Percutaneous Coronary Intervention in Octogenarians: Long-Term Results. Ann Thorac Surg 2015; 99:567-74. [DOI: 10.1016/j.athoracsur.2014.09.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 11/20/2022]
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Moutakiallah Y, Benzaghmout K, Aithoussa M, Atmani N, Amahzoune B, Hatim A, Drissi M, Benyass A, ElBekkali Y, Boulahya A. [Coronary surgery under cardiopulmonary bypass in patients with diabetes]. Pan Afr Med J 2014; 17:199. [PMID: 25396025 PMCID: PMC4229003 DOI: 10.11604/pamj.2014.17.199.2379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 12/05/2013] [Indexed: 11/11/2022] Open
Abstract
Nous rapportons les résultats de la chirurgie coronaire chez une population de coronariens diabétiques opérés sous circulation extra-corporelle dans le service de chirurgie cardiaque de l'hôpital militaire d'instruction Mohammed V de Rabat. C'est une étude rétrospective menée entre Janvier 2008 et Février 2012 (4 ans), portant sur 103 patients diabétiques consécutifs opérés pour pontage coronaire. L’âge moyen des patients était de 61±8,7ans (37-82ans) avec un sexe ratio (H/F) de 3,9. Tous les patients diabétiques de type 2 et sous traitement anti-diabétique ont été inclus dans cette étude. La sténose du tronc commun gauche était présente chez 26,2% des patients et 53,4% étaient tritronculaires. Quatre-vingt patients (78,6%) étaient insulino-nécessitant, l'Euro-score moyen était de 1,63±1% et le nombre moyen de pontage de 2,3±0,7. Les durées moyennes de la circulation extra-corporelle et du clampage aortique étaient respectivement de 134,4 ± 42 min et 76 ± 28 min. La mortalité hospitalière était de 2 décès (1,9%), les durées moyennes de ventilation artificielle, du séjour en réanimation et du séjour postopératoire étaient respectivement de 7h (5-16h), 48h (42-52h) et 15,6 ± 8,6 jours. Les complications postopératoires étaient l'infarctus du myocarde, l'infection de paroi, la médiastinite et le bas débit cardiaque chez respectivement 1,9%, 10,7%, 3,9% et 1,9% des patients. Il ressort de notre étude, que les facteurs prédictifs d'infection post opératoire étaient la durée de ventilation artificielle (p = 0,002), la durée de la circulation extra-corporelle (p < 0,001) en plus du tabac (p = 0,004) et de l'obésité (p = 0,005). Les patients ont été contactés par téléphone ou lors de la consultation régulière de contrôle. Le taux de suivi a atteint 92,1% et la survie à 2 ans était de 98,9% des patients contrôlés avec une mortalité tardive de 1% avec un décès suite à un accident vasculaire cérébral étendu. Le contrôle a montré un cas de ré-hospitalisation pour poussée d'insuffisance cardiaque mais aucun cas de récidive angineuse, d'infarctus du myocarde ou de besoin de revascularisation. La chirurgie coronaire chez le diabétique offre d'excellents résultats à court et à moyen terme au détriment d'une faible morbi-mortalité ce qui en fait le traitement de choix.
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Affiliation(s)
- Younes Moutakiallah
- Service de Chirurgie Cardiaque, Hôpital militaire d'instruction Mohammed V Rabat, Maroc
| | - Khadija Benzaghmout
- Service de Cardiologie, Hôpital militaire d'instruction Mohammed V Rabat, Maroc
| | - Mahdi Aithoussa
- Service de Chirurgie Cardiaque, Hôpital militaire d'instruction Mohammed V Rabat, Maroc
| | - Nourreddine Atmani
- Service de Chirurgie Cardiaque, Hôpital militaire d'instruction Mohammed V Rabat, Maroc
| | - Brahim Amahzoune
- Service de Chirurgie Cardiaque, Hôpital militaire d'instruction Mohammed V Rabat, Maroc
| | - Abdedaim Hatim
- Réanimation de Chirurgie Cardiovasculaire, Faculté de Médecine et de pharmacie. Université Mohammed V, Rabat, Maroc
| | - Mohamed Drissi
- Réanimation de Chirurgie Cardiovasculaire, Faculté de Médecine et de pharmacie. Université Mohammed V, Rabat, Maroc
| | - Aatif Benyass
- Service de Cardiologie, Hôpital militaire d'instruction Mohammed V Rabat, Maroc
| | - Youssef ElBekkali
- Service de Chirurgie Cardiaque, Hôpital militaire d'instruction Mohammed V Rabat, Maroc
| | - Abdelatif Boulahya
- Service de Chirurgie Cardiaque, Hôpital militaire d'instruction Mohammed V Rabat, Maroc
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Thorac Cardiovasc Surg 2014; 149:e5-23. [PMID: 25827388 DOI: 10.1016/j.jtcvs.2014.11.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. Circulation 2014; 130:1749-67. [DOI: 10.1161/cir.0000000000000095] [Citation(s) in RCA: 388] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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10
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Ariyaratne TV, Ademi Z, Yap CH, Billah B, Rosenfeldt F, Yan BP, Reid CM. Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis. Int J Cardiol 2014; 176:346-53. [DOI: 10.1016/j.ijcard.2014.06.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 06/27/2014] [Accepted: 06/29/2014] [Indexed: 12/01/2022]
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Lim JY, Deo SV, Kim WS, Altarabsheh SE, Erwin PJ, Park SJ. Drug-eluting stents versus coronary artery bypass grafting in diabetic patients with multi-vessel disease: a meta-analysis. Heart Lung Circ 2014; 23:717-25. [PMID: 24704466 DOI: 10.1016/j.hlc.2014.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/12/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data comparing long-term results after percutaneous intervention with drug-eluting stents (DES/PCI) and coronary artery grafting (CABG) in diabetic patients (pts) with multi-vessel disease is conflicting. We have conducted a systematic review and meta-analysis to help answer this issue. METHODS MEDLINE, WoS, and Scopus were systematically analysed to yield observational studies (OBS) or randomised controlled trials (RCT) fulfilling search criteria. Odds ratio (OR) for studied end-points were obtained with inverse variance random effects analysis. Results are presented with 95% confidence intervals with significance at p<0.05. RESULTS A total of 14 studies (5 RCT; 9 OBS) including more than 5000 pts were selected for review. Early/30-day was lower in the DES/PCI cohort [OR 0.49(0.27, 0.88); p=0.02; I(2)=0%]. Post-procedural stroke was higher in the CABG (1.8%) cohort compared to DES/PCI (0.17%; p<0.01). A pooled analysis of RCT demonstrated that stroke rate was similar in both cohorts at the end of one year [OR 0.84(0.19, 3.74); p=0.82; I(2) =67%]. During a follow-up of three to five years, repeat intervention was much higher in the DES/PCI cohort [OR 3.02(2.13, 4.28; p<0.01]. The odds of suffering an adverse cardiovascular /cerebrovascular event were 1.71 (1.27, 2.3) times higher in the DES/PCI cohort compared to CABG. CONCLUSION In diabetic patients with multivessel disease, early mortality is lower in the DES/PCI cohort. While peri-procedural stroke rates are lower with PCI, they are, however, comparable at the end of one year. Use of drug-eluting stents leads to a higher rate of re-intervention and major cardiovascular/cerebrovascular events at three to five years.
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Affiliation(s)
- Ju Yong Lim
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester
| | - Salil V Deo
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester; Department of Cardiac Surgery, Adventist Wockhardt Heart Hospital, Surat Gujarat.
| | - Wook Sung Kim
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester; Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | - Soon J Park
- Division of Cardiovascular Surgery, Case Medical Center, Case Western Reserve University, Cleveland OH
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64:1929-49. [PMID: 25077860 DOI: 10.1016/j.jacc.2014.07.017] [Citation(s) in RCA: 554] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Qi X, Xu M, Yang H, Zhou L, Mao Y, Song H, Li Q, Yang C. Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis. Arch Med Sci 2014; 10:411-8. [PMID: 25097568 PMCID: PMC4107246 DOI: 10.5114/aoms.2014.43734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/13/2013] [Accepted: 12/23/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD). MATERIAL AND METHODS A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE). RESULTS Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group. CONCLUSIONS The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics.
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Affiliation(s)
- Xiaolong Qi
- Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mingxin Xu
- Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haitao Yang
- Division of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Lin Zhou
- Division of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Mao
- Division of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haoming Song
- Division of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Quan Li
- Division of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changqing Yang
- Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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De Luca G, Schaffer A, Verdoia M, Suryapranata H. Meta-analysis of 14 trials comparing bypass grafting vs drug-eluting stents in diabetic patients with multivessel coronary artery disease. Nutr Metab Cardiovasc Dis 2014; 24:344-354. [PMID: 24373711 DOI: 10.1016/j.numecd.2013.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/19/2013] [Accepted: 11/23/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Clinical trials have reported lower mortality and repeated revascularization rate in diabetic patients treated with coronary artery bypass grafting (CABG) as compared to percutaneous revascularization. However, these studies were conducted in the era of bare-metal stents. Therefore, we performed a meta-analysis to compare CABG to PCI with drug-eluting stents (DES) in diabetic patients with multivessel and/or left main disease. METHODS AND RESULTS The literature was scanned by formal search of electronic databases (Medline, EMBASE, and Cochrane databases), and major international scientific session abstracts from 2000 to 2013. Primary endpoint was mortality. A total of 14 (4 randomized and 10 non-randomized) trials were finally included, with a total of 7072 patients. Up to 5 years follow-up, CABG was associated with a reduction in mortality (7.3% vs 10.4%, OR[95%CI] = 0.65[0.55-0.77], p < 0.0001; phet = 0.00001), with similar results in both RCTs (OR[95%CI] = 0.64[0.50-0.82], p = 0.0005) and NRCTs (OR[95%CI] = 0.75[0.6-0.94)], p = 0.01) (p int = 0.93). A significant relationship was observed between risk profile and benefits in mortality with CABG (p < 0.001). CABG reduced target vessel revascularization (TVR; 5.2% vs 15.7%, OR[95%CI] = 0.30[0.25-0.36], p < 0.00001, p het = 0.02), with a relationship between risk profile and the benefits from CABG as compared to DES (p < 0.0001). CABG was associated with a lower rate of MACCE (14.9% vs 22.9%, OR[95%CI] = 0.59[0.51-0.67], p < 0.00001, p het<0.00001) but higher risk of CVA (3.6% vs 1.4%, OR[95%CI] = 2.34[1.63-3.35], p < 0.00001, p het = 0.71). CONCLUSIONS The present meta-analysis demonstrates that among diabetic patients with multivessel disease and/or left main disease, CABG provides benefits in mortality and TVR, especially in high-risk patients but it is counterbalanced by a higher risk of stroke. Future trials are certainly needed in the era of new DES and improved antiplatelet therapies.
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Affiliation(s)
- G De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
| | - A Schaffer
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - M Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - H Suryapranata
- Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands
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Hoffman DM, Tranbaugh RF. Interventions for coronary artery disease (surgery vs angioplasty) in diabetic patients. Endocrinol Metab Clin North Am 2014; 43:59-73. [PMID: 24582092 DOI: 10.1016/j.ecl.2013.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with diabetes develop more widespread and more severe atherosclerotic coronary artery disease than patients without diabetes. Medical management of this coronary disease is inferior to revascularization for more complex or more widespread disease. Revascularization by percutaneous intervention (PCI) for patients with diabetes is associated with high mortality and complication rates. Surgical revascularization by coronary artery bypass grafting, yields superior results to PCI for patients with diabetes and coronary artery disease. Patients with diabetes benefit from the same medical management of their coronary artery disease and secondary risk modification as patients without diabetes.
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Affiliation(s)
- Darryl M Hoffman
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, 317 East 17th Street, 11th Floor, New York, NY 10003, USA.
| | - Robert F Tranbaugh
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, 317 East 17th Street, 11th Floor, New York, NY 10003, USA
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Li X, Kong M, Jiang D, Dong A. Comparing coronary artery bypass grafting with drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis. Interact Cardiovasc Thorac Surg 2013; 18:347-54. [PMID: 24345688 DOI: 10.1093/icvts/ivt509] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although drug-eluting stents (DESs) reduce the rate of target vessel revascularization compared with bare-metal stents, the results of DESs for patients with diabetes and multivessel coronary artery disease (CAD) in the DES era are inconsistent. This meta-analysis was undertaken to assess the efficacy and safety of coronary artery bypass grafting (CABG) compared with drug-eluting stent implantation in patients with diabetes mellitus and multivessel coronary artery disease. METHODS We conducted a search of Medline, EMBASE from January 2003 to July 2013 by two reviewers independently, using the terms 'coronary artery bypass graft surgery', 'drug-eluting stent', 'sirolimus-eluting stent', 'paclitaxel-eluting stent', 'diabetes mellitus' and 'multivessel disease', according to established criteria. Studies comparing CABG with DES in patients with diabetes and multivessel CAD with a minimum follow-up of 1 year were included. RESULTS Thirteen studies including 6653 patients with diabetes (3237 who underwent CABG and 3416 who underwent DES implantation) met the selection criteria. The mean follow-up period was 2.9 years (range 1-5). Compared with DES, CABG was associated with a lower risk for major adverse cardiac events (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.46-0.58), driven mainly by a lower risk for repeat revascularization (OR 0.29, 95% CI 0.23-0.35). There was no significant difference with regard to death (OR 0.89, 95% CI 0.75-1.05). Patients in the CABG group had a higher risk for stroke events (OR 2.09, 95% CI 1.45-3.02). CONCLUSIONS Percutaneous coronary intervention with DES in patients with diabetes and multivessel CAD is safe, but has a high risk of long-term repeat revascularization. CABG should remain the standard procedure for diabetic patients with multivessel CAD.
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Affiliation(s)
- Xuebiao Li
- Cardiothoracic Surgery, Department of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Gao F, Zhou YJ, Shen H, Wang ZJ, Yang SW, Liu XL. Meta-analysis of percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with diabetes and left main and/or multivessel coronary artery disease. Acta Diabetol 2013; 50:765-73. [PMID: 22907763 DOI: 10.1007/s00592-012-0411-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 05/30/2012] [Indexed: 12/24/2022]
Abstract
The optimal coronary revascularization strategy for patients with diabetes and left main and/or multivessel disease is undetermined. The aim of our study was to evaluate percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in those patients. We identified 13 articles, published before October 2011, enrolling 6992 patients, whose follow-up period ranged from 1 to 5 years. Patients with PCI had a significant reduction in cerebral vascular attack (CVA) (OR, 0.29; 95 % CI, 0.16-0.51; p < 0.0001, I (2) = 0 %) as compared with CABG, whereas there was a fourfold increased risk of repeat revascularization associated with PCI even using drug-eluting stent (OR, 4.44; 95 % CI, 3.42-5.78; Χ(2) = 4.92, p < 0.00001, I (2) = 0 %). The overall mortality (OR, 0.97; 95 % CI, 0.81-1.15; p = 0.70, I (2) = 0 %) was comparable between the PCI and CABG. However, in subgroup analysis, the composite outcome (death/myocardial infarction/CVA) was significantly reduced in favor of DES implantation (OR, 0.79; 95 % CI, 0.63-0.99; Χ(2) = 1.07, p = 0.04, I (2) = 0 %). Our study confirmed the cerebral vascular benefits of PCI by significantly reducing CVA risks, and the composite outcome was better in patients undergoing PCI with drug-eluting stent, despite a higher repeat revascularization rate. It poses imperative demands for future prospective randomized studies to define the optimal strategy in patients with diabetes and left main and/or multivessel disease.
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Affiliation(s)
- Fei Gao
- Department of Cardiology, An Zhen Hospital, Capital Medical University, Anzhenli Avenue, Chao Yang District, Beijing, 100029, China
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Analysis of Stroke Occurring in the SYNTAX Trial Comparing Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention in the Treatment of Complex Coronary Artery Disease. JACC Cardiovasc Interv 2013; 6:344-54. [DOI: 10.1016/j.jcin.2012.11.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 11/20/2012] [Accepted: 11/29/2012] [Indexed: 11/22/2022]
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012. [PMID: 23182125 DOI: 10.1016/j.jacc.2012.07.013] [Citation(s) in RCA: 1227] [Impact Index Per Article: 102.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Smith SC, Spertus JA, Williams SV, Anderson JL. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012; 126:e354-471. [PMID: 23166211 DOI: 10.1161/cir.0b013e318277d6a0] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Watanabe S, Komiya T, Sakaguchi G, Shimamoto T. Unprotected left main coronary artery disease in patients with low predictive risk of mortality. Ann Thorac Surg 2012; 94:1927-33. [PMID: 22975645 DOI: 10.1016/j.athoracsur.2012.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/22/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND There has been an increasing use of percutaneous coronary intervention with drug-eluting stent (DES) in patients with unprotected left main coronary artery disease. We assessed whether coronary artery bypass grafting (CABG) would be superior to percutaneous coronary intervention with first-generation DES in patients with unprotected left main coronary artery disease. METHODS Between January 2003 and December 2007, a total of 295 patients with unprotected left main coronary artery disease were treated with Kurashiki Central Hospital, Okayama, Japan. Among these patients, 169 and 126 underwent CABG and percutaneous coronary intervention with DES, respectively. The average Society of Thoracic Surgeons' predictive risk of mortality score was 2.3±3.8%. We defined higher-risk and lower-risk patients as those with Society of Thoracic Surgeons' predictive risk of mortality scores higher than 2.3% (CABG, n=48; percutaneous coronary intervention, n=28) and lower than 2.3% (CABG, n=121; percutaneous coronary intervention, n=98), respectively. Survival, major adverse cardiac-related events, and target lesion revascularization were analyzed by the Kaplan-Meier method. RESULTS Between-group differences in favor of CABG were seen with respect to the rate of major adverse cardiac-related events and target lesion revascularization in both strata. In patients with lower scores according to the Society of Thoracic Surgeons' predictive risk of mortality, the cardiac death-free survival rate was significantly higher in CABG. CONCLUSIONS In this 5-year single-center experience, CABG is recommended for unprotected left main coronary artery disease, especially in patients with low scores in the Society of Thoracic Surgeons' predictive risk of mortality.
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Affiliation(s)
- Shun Watanabe
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
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22
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Yi G, Youn YN, Hong S, Song SW, Yoo KJ. Comparison of long-term outcome of off-pump coronary artery bypass grafting versus drug-eluting stents in triple-vessel coronary artery disease. Am J Cardiol 2012; 109:819-23. [PMID: 22177004 DOI: 10.1016/j.amjcard.2011.10.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 10/31/2011] [Accepted: 10/31/2011] [Indexed: 11/26/2022]
Abstract
After the introduction of drug-eluting stents (DESs), percutaneous coronary intervention with DESs has challenged coronary artery bypass grafting as the gold standard for the treatment of 3-vessel coronary artery disease. The purpose of this study was to compare the long-term clinical results between percutaneous coronary intervention with DESs and off-pump coronary artery bypass grafting (OPCAB) in 3-vessel coronary artery disease. Two hundred ninety propensity-score matched patients with 3-vessel coronary artery disease treated by DESs or OPCAB were included. Mean follow-up duration was 58.8 ± 11.5 months (2 to 73) and follow-up rate was 97.9%. Five-year survival rates were 94.8 ± 2.1% in the DES group and 96.5 ± 1.5% in the OPCAB group (p = 0.658). Five-year rates of freedom from major adverse cardiac and cerebrovascular event were 71.6 ± 4.1% in the DES group and 89.6 ± 2.5% in the OPCAB group (p < 0.001). Freedom from nonfatal myocardial infarction and target vessel revascularization rates were the determining factors between the 2 groups (p = 0.018 and p < 0.001, respectively). The OPCAB group showed better clinical outcomes compared to the DES group in 3-vessel coronary artery disease after 5-year follow-up. Freedom from major adverse cardiac and cerebrovascular event rate was significantly higher in the OPCAB group mainly because of the lower incidence of target vessel revascularization and nonfatal myocardial infarction. Longer follow-up with randomization will clarify our present conclusions.
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1719] [Impact Index Per Article: 132.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 896] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Myocardial revascularization by coronary arterial bypass graft: past, present, and future. Curr Probl Cardiol 2011; 36:325-68. [PMID: 21821188 DOI: 10.1016/j.cpcardiol.2011.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The history of coronary artery bypass graft surgery is an amazing story that evolved from a basic understanding of the etiology of coronary artery disease to highly sophisticated methods of restoring blood flow to the myocardium. Adjunctive techniques of anticoagulation, coronary artery imaging, and cardiopulmonary bypass contributed greatly to our ability to provide surgical revascularization. Today, coronary artery bypass graft surgery is the treatment of choice for many patients with complex coronary artery disease. The future will certainly bring improved results with better graft patency with less operative insult and morbidity as the final chapter in the story remains untold.
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Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Ståhle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J 2011; 32:2125-34. [PMID: 21697170 DOI: 10.1093/eurheartj/ehr213] [Citation(s) in RCA: 371] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Greason KL, Schaff HV. Coronary artery bypass graft surgery (CABG) for patients with diabetes and multivessel coronary artery disease: identifying patients who would benefit with CABG and understanding the potential mechanisms involved. Coron Artery Dis 2011; 21:402-6. [PMID: 20706113 DOI: 10.1097/mca.0b013e32833bfde3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment of diabetic patients with multivessel coronary artery disease is controversial. This paper reviews pertinent literature on surgical revascularization with emphasis on which patients benefit from therapy. Recent studies of medical, percutaneous, and surgical therapies have added greatly to our understanding of the treatment of diabetic patients with coronary artery disease. Randomized trials show no advantage with prophylactic percutaneous coronary intervention over medical therapy. However, in patients with more severe three-vessel disease, coronary artery bypass graft surgery (CABG) improved outcomes with respect to reduced myocardial infarction events and cardiac death as compared with medical therapy. In addition, rates of late myocardial infarction and mortality were significantly lower in patients treated with CABG compared with those who received drug-eluting stents. Although the need for subsequent revascularization with drug-eluting stents is reduced compared with angioplasty and bare-metal stents, the rate is still higher than that associated with CABG. CABG reduces risks of myocardial infarction, cardiac death, and need for repeat revascularization in diabetic patients with severe, multivessel coronary artery disease.
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Hong SJ, Kim ST, Kim TJ, Kim EO, Ahn CM, Park JH, Kim JS, Lee KM, Lim DS. Cellular and Molecular Changes Associated With Inhibitory Effect of Pioglitazone on Neointimal Growth in Patients With Type 2 Diabetes After Zotarolimus-Eluting Stent Implantation. Arterioscler Thromb Vasc Biol 2010; 30:2655-65. [DOI: 10.1161/atvbaha.110.212670] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Soon Jun Hong
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
| | - Sung Tae Kim
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
| | - Tae-Jin Kim
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
| | - Eun-Ok Kim
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
| | - Jae Hyoung Park
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
| | - Je Sang Kim
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
| | - Kyung-Mi Lee
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
| | - Do-Sun Lim
- From the Department of Cardiology (S.J.H., C.-M.A., J.H.P., J.S.K., D.-S.L.), Korea University Anam Hospital, Seoul, Korea; and the Department of Biochemistry and Molecular Biology (S.T.K., T.-J.K., E.O.K., K.-M.L.), Korea University College of Medicine, Seoul, Korea
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Nishimi M, Tashiro T. Off-pump coronary artery bypass vs percutaneous coronary intervention. Therapeutic strategies for 3-vessel coronary artery disease: OPCAB vs PCI(PCI-Side). Circ J 2010; 74:2750-7. [PMID: 21084755 DOI: 10.1253/circj.cj-10-1023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary artery bypass graft (CABG) surgery is still the best therapy for patients with multivessel and left main coronary artery disease. Recently, the introduction of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in these patients has improved the restenosis rate compared with bare metal stents. Furthermore, according to the results of the SYNTAX trial, no differences were found in the frequencies of mortality or myocardial infarction between CABG and PCI patients. PCI with DES is being increasingly performed for the treatment of patients with either left main trunk, diffuse, or multivessel lesions. In Japan, to avoid any side effects from cardiopulmonary bypass, off-pump coronary artery bypass (OPCAB) was performed in 66% of the total isolated CABG procedures in 2009, and is markedly different from the procedures performed in North America and Europe. However, the comparative effectiveness of PCI and OPCAB remains uncertain. In the present study, the current evidence from randomized trials, a meta-analysis and several observation studies are reviewed.
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Affiliation(s)
- Masaru Nishimi
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
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Tarantini G, Lanzellotti D. Three-vessel coronary disease in diabetics: personalized versus evidence-based revascularization strategy. Future Cardiol 2010; 6:797-809. [DOI: 10.2217/fca.10.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A steady increase in the number of diabetic patients undergoing coronary revascularization has been recorded in recent years. The causes for this rise are found predominantly in the general demographic development of western industrialized nations, the epidemic progress and wide-spread of diabetes mellitus and changes in assignment behavior. In this article, the specific risk profile of diabetic coronary patients with three-vessel disease in percutaneous or surgical revascularization and tried and tested treatment concepts for this particularly challenging group of patients, with reference to the most recent study results will be presented. Particularly, the peculiarities of coronary heart disease in diabetic patients, the choice of revascularization method, different operative strategies for diabetic patients with coronary heart disease, and challenges faced during follow-up are discussed.
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Affiliation(s)
| | - Davide Lanzellotti
- Department of Cardiac, Thoracic & Vascular Sciences, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy
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From A, Al Badarin F, Cha S, Rihal C. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis of data from the ARTS II, CARDia, ERACI III, and SYNTAX studies and systematic review of observational data. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i2a43] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lee MS, Yang T, Dhoot J, Iqbal Z, Liao H. Meta-analysis of studies comparing coronary artery bypass grafting with drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease. Am J Cardiol 2010; 105:1540-4. [PMID: 20494658 DOI: 10.1016/j.amjcard.2010.01.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/11/2010] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
Abstract
This meta-analysis was undertaken to assess the efficacy and safety of coronary artery bypass grafting (CABG) compared to drug-eluting stenting (DES) in patients with diabetes mellitus and multivessel coronary artery disease (CAD). CABG has been the preferred revascularization strategy in patients with diabetes compared to DES. Drug-eluting stents reduce the rate of target vessel revascularization compared to bare-metal stents. The ideal revascularization strategy for patients with diabetes with multivessel CAD in the DES era is unknown. A search of published reports was performed to identify clinical studies comparing CABG with DES in patients with diabetes with multivessel CAD with a minimum follow-up of 1 year. Five studies including 1,543 patients with diabetes (757 who underwent CABG and 786 who underwent DES) met the selection criteria. The mean follow-up period was 18 months (range 12 to 36). Compared to DES, CABG was associated with a lower risk for major adverse cardiac events (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.36 to 0.65), driven mainly by a lower risk for repeat revascularization (OR 0.18, 95% CI 0.11 to 0.30), despite having a higher percentage of triple-vessel disease. There was no significant difference in death (OR 0.85, 95% CI 0.52 to 1.39) or myocardial infarction (OR 0.82, 95% CI 0.41 to 1.61). Patients in the CABG group had a higher risk for cerebrovascular events (OR 2.15, 95% CI 0.99 to 4.68). In conclusion, PCI with DES is safe and may represent a viable alternative to CABG for selected patients with diabetes with multivessel CAD.
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Ji Q, Mei Y, Wang X, Feng J, Cai J, Sun Y, Chi L. Impact of diabetes mellitus on patients over 70 years of age undergoing coronary artery bypass grafting. Heart Lung 2010; 39:404-9. [PMID: 20561845 DOI: 10.1016/j.hrtlng.2009.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 09/15/2009] [Accepted: 10/03/2009] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We evaluated in-hospital outcomes of diabetic and nondiabetic patients aged over 70 years after isolated coronary artery bypass grafting (CABG). PATIENTS AND SETTING All patients aged over 70 years at our center, who underwent CABG between January 2003 and December 2008, were entered into this study. Diabetes in this study was defined as the need for oral medication or insulin. METHODS The relevant preoperative, intraoperative, and postoperative characteristics of selected patients were investigated, compiled, and retrospectively analyzed. RESULTS One hundred and twenty-one diabetic patients aged over 70 years, accounting for 30.8% of the total population, were entered into this study. Diabetic patients aged over 70 years were more likely to present with left main trunk disease (P=.0194), and less likely to have undergone previous percutaneous coronary intervention (P=.0121), compared with their nondiabetic counterparts. Univariate and multivariate logistic regression analysis showed that diabetic patients aged over 70 years had a higher rate only of deep sternal wound infection (odds ratio, 2.28; 95% confidence interval, 1.29 to 6.84; P=.0028), while sharing similar rates for other morbidities and mortality compared with nondiabetic patients aged over 70 years. CONCLUSIONS Elderly diabetic patients are not at significantly increased risk from CABG, compared with their nondiabetic peers.
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Affiliation(s)
- Qiang Ji
- Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University, Shanghai, People's Republic of China
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Banning AP, Westaby S, Morice MC, Kappetein AP, Mohr FW, Berti S, Glauber M, Kellett MA, Kramer RS, Leadley K, Dawkins KD, Serruys PW. Diabetic and Nondiabetic Patients With Left Main and/or 3-Vessel Coronary Artery Disease. J Am Coll Cardiol 2010; 55:1067-75. [PMID: 20079596 DOI: 10.1016/j.jacc.2009.09.057] [Citation(s) in RCA: 217] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 09/16/2009] [Accepted: 09/30/2009] [Indexed: 11/18/2022]
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Drug-eluting stents versus bypass surgery for multivessel coronary disease. CURRENT CARDIOVASCULAR RISK REPORTS 2009. [DOI: 10.1007/s12170-009-0049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lexis CPH, Rahel BM, Meeder JG, Zijlstra F, van der Horst ICC. The role of glucose lowering agents on restenosis after percutaneous coronary intervention in patients with diabetes mellitus. Cardiovasc Diabetol 2009; 8:41. [PMID: 19635170 PMCID: PMC2727510 DOI: 10.1186/1475-2840-8-41] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 07/28/2009] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The prevalence of diabetes is increasing rapidly, and individuals with diabetes are at high risk for cardiovascular disorders. Subsequently the percentage of patients with diabetes subjected to revascularisation, i.e. either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) also rises rapidly. The outcome of patients with diabetes after PCI is worse than for patients without diabetes. Restenosis is the main limiting factor of the long-term success of PCI. Although stents and antithrombotics improved outcome after PCI in both diabetics and non-diabetics, diabetics still have a worse prognosis. This leads to the suggestion that the restenosis mechanism in diabetics might be different from that in non-diabetics. CONCLUSION Several glucose lowering agents have been shown to influence the restenosis process and thus the outcome after PCI. Current data of especially metformin and thiazolidinediones indicate beneficial results as compared to insulin and sulfonylurea on restenosis. However, no large trials have been undertaken in which the effect of glucose lowering agents on restenosis is associated with improved outcome.The purpose of this review is to summarize the effect of diabetes and glucose lowering agents on restenosis.
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Affiliation(s)
- Chris P H Lexis
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands.
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40
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Cook S, Windecker S. Surgical versus percutaneous revascularization of coronary artery disease in diabetic patients. Best Pract Res Clin Endocrinol Metab 2009; 23:317-34. [PMID: 19520306 DOI: 10.1016/j.beem.2008.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Morbidity and mortality related to coronary artery disease (CAD) remain a great challenge in patients with diabetes mellitus. Revascularization of CAD is an important therapeutic intervention owing to its impact on both symptoms and prognosis. The optimal revascularization strategy continues to evolve due to the advent of new technologies and improved peri-procedural outcome with both percutaneous coronary interventions and coronary artery bypass grafting. Although clinical outcome following coronary artery bypass is worse in diabetic as opposed to non-diabetic patients, surgical revascularization tends to be associated with better outcome in stable patients with multivessel disease and reduced left ventricular function. The advent of drug-eluting stents has challenged the supremacy of coronary artery bypass grafting and has become a valuable alternative to surgery. The safety and efficacy of drug-eluting stents in the treatment of patients with diabetes and multivessel disease is currently under investigation in several ongoing randomized controlled trials. Percutaneous coronary intervention is the therapy of choice in patients with acute coronary syndromes, particularly ST-elevation myocardial infarction. The focus of this review is to present the current evidence, define the role of percutaneous and surgical revascularization in the treatment of diabetic patients with CAD, and propose a tailored approach for clinical decision-making.
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Affiliation(s)
- Stéphane Cook
- Invasive Cardiology, Department of Cardiology, University Hospital Bern, 3010 Bern, Switzerland
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Hage C, Norhammar A, Grip L, Malmberg K, Sarkar N, Svane B, Rydén L. Glycaemic control and restenosis after percutaneous coronary interventions in patients with diabetes mellitus: a report from the Insulin Diabetes Angioplasty study. Diab Vasc Dis Res 2009; 6:71-9. [PMID: 20368196 DOI: 10.1177/1479164109336042] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated the impact of glucose control on target lesion restenosis after PCI in patients with type 2 diabetes. METHODS Ninety-three consecutive patients with type 2 diabetes accepted for PCI were randomised to intensified glucose control based on insulin (I-group; n=44) or to continue ongoing glucose-lowering treatment (C-group; n=49).The treatment target was a FBG of 5-7 mmol/L and HbA1c <6.5%. Information on target lesion restenosis after six months was available in 82 patients. RESULTS At baseline HbA1c and FBG did not differ between the I- and C-groups, respectively (HbA1c: 6.5 vs. 6.5%; p=1.0 and FBG: 7.0 vs. 7.3 mmol/L; p=0.3). After six months there was no significant change in HbA1c or FBG in either group (change in HbA1c: -0.2 vs.-0.1%; p=0.3 and in FBG: +0.2 vs. -0.3 mmol/L; p=0.3 in the I- and C-groups, respectively). Target lesion restenosis at six months did not differ, I vs. C = 41 and 44% (p=0.8). Independent predictors for restenosis were previous myocardial infarction (OR 8.0, 95% CI 2.5-25.7; p=<0.001) and FBG at baseline (OR for an increase by 1 mmol/L = 1.4, 95% CI 1.1-1.9; p=0.015). CONCLUSIONS Restenosis was predicted by baseline FBG suggesting that it would be of interest to target glucose normalisation in future trials. Intensified insulin treatment did not influence the rate of restenosis indicating that the main focus should be on lowering glucose rather than the tool to normalise glucose.
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Affiliation(s)
- Camilla Hage
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360:961-72. [PMID: 19228612 DOI: 10.1056/nejmoa0804626] [Citation(s) in RCA: 2868] [Impact Index Per Article: 191.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point--a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry. RESULTS Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001); as a result, the criterion for noninferiority was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P=0.003). CONCLUSIONS CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year. (ClinicalTrials.gov number, NCT00114972.)
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Affiliation(s)
- Patrick W Serruys
- Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Teirstein PS. Percutaneous Revascularization Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis. Circulation 2009; 119:1021-33. [PMID: 19237673 DOI: 10.1161/circulationaha.107.759712] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul S. Teirstein
- From the Department of Cardiology, Interventional Cardiology, Scripps Clinic, La Jolla, Calif
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Menasché P. Revascularisation myocardique 30 ans après : la chirurgie toujours d’actualité. Presse Med 2008; 37:1569-74. [DOI: 10.1016/j.lpm.2008.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 01/02/2008] [Indexed: 11/29/2022] Open
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Comparison of Off-pump Coronary Artery Bypass Grafting With Percutaneous Coronary Intervention Versus Drug-Eluting Stents for Three-Vessel Coronary Artery Disease. Ann Thorac Surg 2008; 86:1438-43. [DOI: 10.1016/j.athoracsur.2008.07.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 07/01/2008] [Accepted: 07/07/2008] [Indexed: 11/20/2022]
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Percutaneous coronary intervention or bypass surgery: Which to choose? JAAPA 2008; 21:36-9. [DOI: 10.1097/01720610-200808000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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