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Muoghalu CG, Ofoegbu CC, Ekong NE, Ebirim DA, Alex-Ojei ST, Alqahtani F. Systematic Review of the Efficacy of Orbital Atherectomy in Improving the Outcome of Percutaneous Corornary Intervention in People With Diabetes. Cureus 2023; 15:e50153. [PMID: 38186553 PMCID: PMC10771627 DOI: 10.7759/cureus.50153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
The optimal approach to deal with severe coronary artery calcification (CAC) in people with diabetes remains ill-defined. People with diabetes have a significant risk of developing severe vessel calcification and coronary artery disease (CAD). CAD is the leading cause of death in people with diabetes. Individuals with diabetes mainly present with severe multivessel stenosis, diffuse coronary calcification, and severe atherosclerosis, which are poor prognostic factors of revascularization procedures. Studies have shown that the revascularization of arteries in people with diabetes often results in worse outcomes than in people without diabetes. Coronary artery bypass grafting (CABG) has been recommended as the standard of care for people with DM and complex anatomic diseases, including left main CAD. However, percutaneous coronary intervention (PCI) is more acceptable to patients in clinical practice because of decreased trauma and rapid recovery. Severe CAC has traditionally been challenging for PCI and a frequent indication for surgical revascularization. This study aims to determine the effectiveness of orbital atherectomy (OA) in improving PCI outcomes in patients with diabetes and identify possible adverse effects that preclude its use. The study is reported according to PRISMA and analyzed according to Cochrane guidelines on synthesis without meta-analysis. A comprehensive literature search of EMBASE, Scopus, Web of Science, Cochrane Library, CINAHL, and MEDLINE was conducted for studies that utilized OA before PCI in people with diabetes. A reference list of the eligible articles was also screened. A narrative synthesis was done by representing the data on the effect direction plot, followed by vote counting. Eighteen studies were included in the analysis. Success rate/successful stent delivery was >90%, while freedom from angiographic complication and major adverse cardiovascular and cerebrovascular events (MACCE) were both >80% on the effect direction plot for people with diabetes and those without diabetes. People with diabetes had low event rates similar to those without diabetes. OA appears to be a viable treatment approach for people with diabetes. However, RCTs with a longer duration of follow-up are required to establish the appropriate treatment strategy for severe CAC in people with diabetes.
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Affiliation(s)
| | - Cosmas C Ofoegbu
- Health Sciences, Central Washington College, Enugu, NGA
- Community and Family Medicine, Allith General Hospital, Allith, SAU
| | | | - Danvictor A Ebirim
- Department of Medicine, Federal University Teaching Hospital, Owerri, NGA
| | - Sandra T Alex-Ojei
- Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, NGA
| | - Foziyah Alqahtani
- Department of Cardiac Technology, Imam Abdurahman Bin Faisal University, Dammam, SAU
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González-Juanatey C, Anguita-Sánchez M, Barrios V, Núñez-Gil I, Gómez-Doblas JJ, García-Moll X, Lafuente-Gormaz C, Rollán-Gómez MJ, Peral-Disdier V, Martínez-Dolz L, Rodríguez-Santamarta M, Viñolas-Prat X, Soriano-Colomé T, Muñoz-Aguilera R, Plaza I, Curcio-Ruigómez A, Orts-Soler E, Segovia-Cubero J, Fanjul V, Marín-Corral J, Cequier Á. Impact of Advanced Age on the Incidence of Major Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Stable Coronary Artery Disease in a Real-World Setting in Spain. J Clin Med 2023; 12:5218. [PMID: 37629262 PMCID: PMC10456002 DOI: 10.3390/jcm12165218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead® technology, which is based on natural language processing and machine learning, to extract unstructured clinical information from electronic health records (EHRs) from 12 hospitals. Of the 4072 included patients, 30.9% were younger than 65 years (66.3% male), 34.2% were aged 65-75 years (66.4% male), and 34.8% were older than 75 years (54.3% male). These older patients were more likely to have hypertension (OR 2.85), angina (OR 1.64), heart valve disease (OR 2.13), or peripheral vascular disease (OR 2.38) than those aged <65 years (p < 0.001 for all comparisons). In general, they were also more likely to receive pharmacological and interventional treatments. Moreover, these patients had a significantly higher risk of MACEs (HR 1.29; p = 0.003) and ischemic stroke (HR 2.39; p < 0.001). In summary, patients with T2DM-CAD in routine clinical practice tend to be older, have more comorbidities, are more heavily treated, and have a higher risk of developing MACE than is commonly assumed from clinical trial data.
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Affiliation(s)
| | - Manuel Anguita-Sánchez
- Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, 14014 Cordoba, Spain;
| | | | - Iván Núñez-Gil
- Cardiology Department, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain;
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Juan José Gómez-Doblas
- IBIMA (Instituto de Investigación Biomédica de Málaga), Hospital Universitario Virgen de la Victoria, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), 29010 Malaga, Spain;
| | - Xavier García-Moll
- Hospital Universitario Santa Creu i Sant Pau, 08041 Barcelona, Spain; (X.G.-M.); (X.V.-P.)
| | | | | | | | - Luis Martínez-Dolz
- Hospital Universitario y Politécnico La Fe, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), IIS La Fe, 46026 Valencia, Spain;
| | | | - Xavier Viñolas-Prat
- Hospital Universitario Santa Creu i Sant Pau, 08041 Barcelona, Spain; (X.G.-M.); (X.V.-P.)
| | - Toni Soriano-Colomé
- Hospital Vall d’Hebron, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), 08035 Barcelona, Spain;
| | | | | | | | - Ernesto Orts-Soler
- Hospital General Universitario de Castellón, 12004 Castellon de la Plana, Spain;
| | | | - Víctor Fanjul
- Savana Research SL, 28013 Madrid, Spain; (V.F.); (J.M.-C.)
| | | | - Ángel Cequier
- Hospital Universitario de Bellvitge, IDIBELL (Instituto de Investigación Biomédica de Bellvitge), Universidad de Barcelona, 08007 Barcelona, Spain;
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Ge Y, He D, Shao Y, Wang L, Yan W. Percutaneous coronary intervention in insulin-treated diabetic patients: A meta-analysis. Ann Noninvasive Electrocardiol 2022; 27:e12953. [PMID: 35467783 PMCID: PMC9484026 DOI: 10.1111/anec.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background This meta‐analysis of randomized controlled trials (RCTs) compared long‐term adverse clinical outcomes of percutaneous coronary intervention (PCI) in insulin‐treated diabetes mellitus (ITDM) and non‐ITDM patients. Methods This is a meta‐analysis study. The PubMed and Embase databases were searched for articles on long‐term adverse clinical outcomes of PCI in ITDM and non‐ITDM patients. The risk ratios (RR) and 95% confidence intervals (CI) were calculated. Results A total of 11 related RCTs involving 8853 DM patients were included. Compared with non‐ITDM patients, ITDM patients had significantly higher all‐cause mortality (ACM) (RR = 1.52, 95% CI: 1.25–1.85, pheterogeneity = .689, I2 = 0%), major adverse cardiac and cerebrovascular events (MACCE) (RR = 1.35, 95% CI: 1.18–1.55, pheterogeneity = .57, I2 = 0%), myocardial infarction (MI) (RR = 1.41, 95% CI: 1.16–1.72, pheterogeneity = .962, I2 = 0%), and stent thrombosis (ST) (RR = 1.75, 95% CI: 1.23–2.48, pheterogeneity = .159, I2 = 32.4%). No significant difference was found in the target lesion revascularization (TLR) and target vessel revascularization (TVR) between the ITDM and non‐ITDM groups. Conclusions The results showed that ITDM patients had significantly higher ACM, MACCE, MI, and ST, compared with non‐ITDM patients.
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Affiliation(s)
- Ying Ge
- Department of General Practice, Jinshan Hospital of Fudan University, Shanghai, China
| | - Daikun He
- Department of General Practice, Jinshan Hospital of Fudan University, Shanghai, China.,Center of Emergency & Intensive Care Unit, Jinshan Hospital of Fudan University, Shanghai, China
| | - Yiru Shao
- Center of Emergency & Intensive Care Unit, Jinshan Hospital of Fudan University, Shanghai, China
| | - Lina Wang
- Department of General Practice, Jinshan Hospital of Fudan University, Shanghai, China
| | - Wei Yan
- Department of General Practice, Jinshan Hospital of Fudan University, Shanghai, China
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Coronary Revascularization for Patients with Diabetes Mellitus: A Contemporary Systematic Review and Meta-Analysis. Ann Surg 2022; 275:1058-1066. [PMID: 35081569 DOI: 10.1097/sla.0000000000005391] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aims to review the contemporary literature comparing CABG and PCI in diabetic patients providing an up-to-date perspective on the differences between the interventions. BACKGROUND Diabetes is common and diabetic patients are at a 2-to-4-fold increased risk of developing coronary artery disease. Approximately 75% of diabetic patients die of cardiovascular disease. Previous literature has identified CABG as superior to PCI for revascularization in diabetic patients with complex coronary artery diseas. METHODS PubMed and Medline were systematically searched for articles published from January 1, 2015 to April 15, 2021. This systematic review included all retrospective, prospective, and randomized trial studies comparing CABG and PCI in diabetic patients. 1552 abstracts were reviewed and 25 studies were included in this review. The data was analyzed using the RevMan 5.4 software. RESULTS Diabetic patients undergoing CABG experienced significantly reduced rates of 5-year mortality, major adverse cardiovascular and cerebrovascular events, myocardial infarction, and required repeat revascularization. Patients who underwent PCI experienced improved rates of stroke that trended toward significance. CONCLUSIONS Previous literature regarding coronary revascularization in diabetic patients has consistently demonstrated superior outcomes for patients undergoing CABG over PCI. The development of 1st and 2nd generation DES have narrowed the gap between CABG and PCI, but CABG continues to be superior. Continued investigation with large randomized trials and retrospective studies including long term follow-up comparing CABG and 2nd generation DES is necessary to confirm the optimal intervention for diabetic patients.
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Askin L. The Clinical Value of Syntax Scores in Predicting Coronary Artery Disease Outcomes. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2022. [DOI: 10.15212/cvia.2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) hassignificantly improved angiographic risk stratification. By analyzing angiographic variables, this score characterizescoronary artery disease qualitatively and quantitatively. To date, combining this score with other non-angiographic clinicalscores has broadened perspectives regarding risk estimation, and future research on this topic appears promising.
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Zafiraki VK, Kosmacheva ED, Mirzaev SG, Shulzhenko LV, Ramazanov JM, Omarov AA, Imetova ZB, Pershukov IV. Chronic obstructive pulmonary disease in patients with coronary heart disease worsens long-term prognosis after percutaneous coronary interventions. KARDIOLOGIIA 2021; 61:24-32. [PMID: 34882075 DOI: 10.18087/cardio.2021.11.n1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
Aim To evaluate the incidence rate of major adverse cardiovascular events (MACVE) in the long-term following percutaneous coronary interventions (PCCI) in patients with acute and chronic ischemic heart disease (IHD) and the contribution of concurrent chronic obstructive pulmonary disease (COPD) to the long-term prediction.Material and methods This prospective cohort study included 254 patients with IHD and concurrent COPD and 392 patients with IHD without COPD. PCCI was performed in all patients: for acute coronary syndrome in 295 patients and for chronic IHD in 351 patients. The follow-up period lasted for up to 36 months. The outcome was a composite endpoint, MACVE, that included cardiovascular death, myocardial infarction, stroke, repeated unscheduled myocardial revascularization (MR), and the time to the event.Results The age-standardized incidence of MACVE in patients with IHD and COPD was 31.5 vs. 23.2 % in patients with IHD without concurrent COPD (p=0.025), primarily due to an increased frequency of repeated unscheduled MR (20.5 vs. 14.0 %, p=0.041), which was associated with earlier occurrence of adverse events (p<0.001). Repeated unscheduled MR was more frequently performed in patients with moderate COPD; the frequency of MR decreased with increasing severity of COPD, whereas the total incidence of cardiovascular death, myocardial infarction, and stroke was the highest in patients with severe and very severe COPD.Conclusion The presence of concurrent COPD increases the relative risk of MACVE 1.36 times (95 % confidence interval: 1.05-1.75) and facilitates their earlier development. Repeated unscheduled MR makes the major contribution to the increase in the total risk (relative risk, 1.46; 95 % confidence interval: 1.03-2.06). The increase in severity of COPD is associated with the increase in total frequency of MACVE (p=0.005).
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Affiliation(s)
- V K Zafiraki
- Kuban State Medical University of the Ministry of Healthcare, Krasnodar, Russia Regional Clinical Hospital #1, Krasnodar, Russia
| | - E D Kosmacheva
- Kuban State Medical University of the Ministry of Healthcare, Krasnodar, Russia Scientific Research Institution - S.V.Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - S G Mirzaev
- Kuban State Medical University of the Ministry of Healthcare, Krasnodar, Russia
| | - L V Shulzhenko
- Kuban State Medical University of the Ministry of Healthcare, Krasnodar, Russia Scientific Research Institution - S.V.Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | | | - A A Omarov
- Cardiology and Internal Diseases Institute, Almaty, Kazakhstan
| | | | - I V Pershukov
- Osh State University, Osh, Kyrgyzstan Voronezh Regional Clinical Hospital #1, Voronezh, Russia
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Pei J, Wang X, Xing Z. Traditional Cardiovascular Risk Factors and Coronary Collateral Circulation: A Meta-Analysis. Front Cardiovasc Med 2021; 8:743234. [PMID: 34805302 PMCID: PMC8595282 DOI: 10.3389/fcvm.2021.743234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Patients with well-developed coronary collateral circulation (CC) usually have low mortality, improved cardiac function, and reduced infarct size. Currently, there is conflicting evidence on the association between traditional cardiovascular risk factors (diabetes, hypertension, and smoking habit) and CC. Design: We performed a meta-analysis of case-control studies to better understand such associations. Data Sources: We searched the MEDINE, EMBASE, and Science Citation Index databases to identify relevant studies. Eligibility Criteria for Selecting Studies: Case control studies reporting data on risk factors (smoking habit, hypertension, and diabetes mellites) in comparing cases between poor CC and well-developed CC groups. Well-developed CC was the primary outcome of this meta-analysis Data Extraction and Synthesis: Relevant data were extracted by two independent investigators. We derived pooled odds ratios (ORs) with random effects models. We performed quality assessments, publication bias, and sensitivity analysis to ensure the reliability of our results. Results: In total, 18 studies that had 4,746 enrolled patients were analyzed. Our results showed that hypertension and smoking habit did not (OR = 0.94, 95% CI: 0.75–1.17, p = 0.564 and OR = 1.00, 95% CI: 0.84–1.18, p = 0.970, respectively), and diabetes did (OR = 0.50, 95% CI: 0.38–0.67, p = 0.00001) affect the development of CC. Conclusion: Unlike hypertension and smoking habit, diabetes was associated with poor CC formation. Trial Registration Number:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=87821, identifier: CRD42018087821.
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Affiliation(s)
- Junyu Pei
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaopu Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, China
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Liang B, He X, Gu N. Reassessing Revascularization Strategies in Coronary Artery Disease and Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:738620. [PMID: 34746255 PMCID: PMC8568070 DOI: 10.3389/fcvm.2021.738620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 01/11/2023] Open
Abstract
Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is still controversial in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). Here, we aimed to evaluate the long-term follow-up events of PCI and CABG in these populations. Relevant randomized controlled trials were retrieved from PubMed, Embase, and the Cochrane databases. The pooled results were represented as risk ratios (RRs) with 95% confidence intervals (CIs) with STATA software. A total of six trials with 1,766 patients who received CABG and 2,262 patients who received PCI were included in our study. Patients in the CABG group were significantly associated with a lower all-cause mortality compared with those in the PCI group (RR = 0.74, 95% CI = 0.56–0.98, P = 0.037). Cardiac mortality, recurrent myocardial infarction, and repeat revascularization were also significantly lower in the CABG group (RR = 0.79, 95% CI = 0.40–1.53, P = 0.479; RR = 0.70, 95% CI = 0.32–1.56, P = 0.387; and RR = 0.36, 95% CI = 0.28–0.46, P < 0.0001; respectively). However, compared with the PCI group, the cerebral vascular accident was higher in the CABG group (RR = 2.18, 95% CI = 1.43–3.33, P < 0.0001). There was no publication bias in our study. CABG revascularization was associated with significantly lower long-term adverse clinical outcomes, except cerebral vascular accident, compared with PCI in patients with CAD and T2DM. Systematic Review Registration: PROSPERO, identifier: CRD42020216014.
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Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Xin He
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Ning Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
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Wang H, Wang H, Wei Y, Li X, Jhummun V, Ahmed MA. Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis. Diabetes Ther 2021; 12:1041-1054. [PMID: 33641081 PMCID: PMC7994472 DOI: 10.1007/s13300-021-01025-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/08/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION In this meta-analysis, we aimed to systematically compare the 10-year outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with type 2 diabetes mellitus (T2DM) suffering from left main coronary artery disease (LMCD). METHODS Medical Literature Analysis and Retrieval System Online (MEDLINE), http://www.ClinicalTrials.gov , Excerpta Medica dataBASE (EMBASE), Cochrane Central, Web of Science, and Google scholar were searched for publications comparing 10-year outcomes of PCI versus CABG in patients with T2DM suffering from LMCD. Cardiovascular outcomes were considered as the clinical endpoints. Statistical analysis was carried out using RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after analysis. RESULTS Eight studies (three randomized trials and five observational studies) with a total number of 3835 participants with T2DM were included in this analysis; 2340 participants were assigned to the PCI group and 1495 participants were assigned to the CABG group. Results of this analysis showed that mortality (RR 0.85, 95% CI 0.73-1.00; P = 0.05), myocardial infarction (RR 0.53, 95% CI 0.35-0.80; P = 0.002), repeated revascularization (RR 0.34, 95% CI 0.26-0.46; P = 0.00001), and target vessel revascularization (RR 0.26, 95% CI 0.18-0.38; P = 0.00001) were significantly higher with PCI when compared to CABG in these patients with diabetes and LMCD. Major adverse cardiac and cerebrovascular events were also significantly higher with PCI at 10 years (RR 0.67, 95% CI 0.49-0.92; P = 0.01). However, CABG was associated with a significantly higher risk of stroke (RR 2.16, 95% CI 1.39-3.37; P = 0.0007). CONCLUSIONS During a long-term follow-up time period of 10 years, PCI was associated with worse clinical outcomes compared to CABG in these patients with T2DM suffering from LMCD. However, a significantly higher risk of stroke was observed with CABG. This piece of information might be vital in order to carefully choose and prevent complications following revascularization in such patients.
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Affiliation(s)
- Hong Wang
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China.
| | - Hongli Wang
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China
| | - Yuyuan Wei
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China
| | - Xinxin Li
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, People's Republic of China
| | - Vineet Jhummun
- Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Mohamad A Ahmed
- Department of Cardiology, Peking University People's Hospital, Beijing, People's Republic of China
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Haqzad Y, Hobkirk J, Ariyaratnam P, Chaudhry M, Carroll S, Loubani AM. Outcomes following coronary artery bypass surgery in diabetic treatment sub-groups. A propensity matched analysis of >7000 patients over 18 years. Asian Cardiovasc Thorac Ann 2021; 30:131-140. [PMID: 33730864 DOI: 10.1177/0218492321999551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND European System for Cardiac Operative Risk Evaluation II incorporates insulin-controlled diabetes whilst omitting tablet-controlled diabetes. Differences in adverse clinical outcomes following coronary artery bypass graft between these groups are poorly established. Therefore, a propensity matched comparison of short and longer term mortality and morbidity in insulin-controlled diabetes, tablet-controlled diabetes and non-diabetic patients was undertaken. METHODS Isolated first-time coronary artery bypass graft surgeries between April 1999 and April 2017 were propensity score matched by pre- and intra-operative variables. RESULTS 8241 patients; 23.5% diabetics and 76.5% non-diabetics. The groups' demographical and clinical characteristics were comparable after matching. Insulin-controlled diabetes patients had significantly higher in-hospital mortality (3.8% vs. 1.7%, p < 0.05), multisystem failure (2.6% vs. 1.8%, p < 0.05), sternal wound infections requiring debridement (3.6% vs. 1.3%, p < 0.05), respiratory complications (25.6% vs. 21.9%, p < 0.05), new dialysis (4.7% vs. 0.9%, p < 0.05) and longer hospital stays (13.5 ± 13.3 vs. 10.6 ± 8.0, p < 0.05) compared to non-diabetic patients.Tablet-controlled diabetes patients had significantly higher strokes (2.9% vs. 1.2, p < 0.05), superficial sternal wound infections (6.7% vs. 5.4%, p < 0.05), respiratory complications (25.7% vs. 22.7%, p < 0.05), new dialysis (1.7% vs. 0.6%, p < 0.05), post-operative atrial fibrillation (37.1% vs. 33.9%, p < 0.05) and readmission with myocardial infarction (22.4% vs. 19.6%, p < 0.05) compared to non-diabetic patients. CONCLUSION Diabetic treatment sub-groups are an independent risk factor for sternal wound infection, new dialysis requirement, multisystem failure and readmission with myocardial infarction after isolated first coronary artery bypass graft surgery. The findings suggest the need for better risk stratification of diabetic groups prior to cardiac surgery and for improved cardiovascular risk management post-surgery in tablet-controlled diabetes patients.
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Affiliation(s)
- Yama Haqzad
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | - James Hobkirk
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Mubarak Chaudhry
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
| | - Sean Carroll
- Faculty of Health Sciences, University of Hull, Hull, UK
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Petrakova ES, Savina NM, Molochkov AV. [Atrial Fibrillation After Coronary Artery Bypass Surgery: Risk Factors, Prevention and Treatment]. ACTA ACUST UNITED AC 2020; 60:134-148. [PMID: 33131484 DOI: 10.18087/cardio.2020.9.n1074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
This review focuses on the issue of atrial fibrillation (AF) following coronary bypass surgery in patients with ischemic heart disease. Risk factors of this complication are discussed in detail. The authors addressed the effect of diabetes mellitus on development of postoperative AF. Data on current methods for prevention and treatment of AF are provided.
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Affiliation(s)
- E S Petrakova
- Central Clinical Hospital with Out-patient Clinic of the Department of Affairs of the President of the Russian Federation, Moscow
| | - N M Savina
- Central State Medical Academy of Department of Presidential Affairs, Moscow
| | - A V Molochkov
- Central Clinical Hospital with Out-patient Clinic of the Department of Affairs of the President of the Russian Federation, Moscow
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12
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Zhai C, Cong H, Hou K, Hu Y, Zhang J, Zhang Y. Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies. Diabetol Metab Syndr 2019; 11:110. [PMID: 31890044 PMCID: PMC6923849 DOI: 10.1186/s13098-019-0506-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The optimal revascularization technique in diabetic patients with complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD), remains controversial. The current study aimed to compare adverse clinical endpoints of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM). METHODS Relevant studies were found from MEDLINE, OVID, Science Direct, Embase and the Cochrane Central database from January 2010 to April 2019. Risk ratio (RR) with 95% confidence interval (CI) was used to express the pooled effect on discontinuous variables. Outcomes evaluated were all-cause mortality, major adverse cardiac/cerebrovascular events (MACCE), cardiac death, myocardial infarction, stroke, and repeat revascularization. RESULTS Sixteen studies were included (18,224 patients). PCI was associated with the increase risk for MACCE (RR 1.59, 95% CI 1.38-1.85), cardiac death (RR 1.76, 95% CI 1.11-2.80), MI (RR 1.98, 95% CI 1.53-2.57), repeat revascularization (RR 2.61, 95% CI 2.08-3.29). The risks for all-cause mortality (RR 1.23, 95% CI 1.00-1.52) and stroke (RR 0.71, 95% CI 0.48-1.03) were similar between two strategies. Stratified analysis based on studies design and duration of follow-up showed largely similar findings with the overall analyses, except for a significant increased risk of all-cause mortality (RR 1.32, 95% CI 1.04-1.67) in long-term group, and CABG was associated with a higher stroke rate compared to PCI, which are results that were found in RCTs (RR 0.47, 95% CI 0.28-0.79) and mid-term groups (RR 0.39, 95% CI 0.23-0.66). CONCLUSIONS CABG was superior to PCI for diabetic patients with complex CAD (including left main CAD and/or MVD), but might be associated with a higher risk of stroke mid-term follow-up.Number of Protocol registration PROSPERO CRD 42019138505.
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Affiliation(s)
- ChuanNan Zhai
- School of Medicine, NanKai University, Weijin Road No. 94, Nankai District, Tianjin, 300071 China
- Department of Cardiology, Tianjin Chest Hospital, Taierzhuang South Road No. 291, Jinnan District, Tianjin, 300350 China
| | - HongLiang Cong
- School of Medicine, NanKai University, Weijin Road No. 94, Nankai District, Tianjin, 300071 China
- Department of Cardiology, Tianjin Chest Hospital, Taierzhuang South Road No. 291, Jinnan District, Tianjin, 300350 China
| | - Kai Hou
- School of Medicine, NanKai University, Weijin Road No. 94, Nankai District, Tianjin, 300071 China
- Department of Cardiology, Tianjin Chest Hospital, Taierzhuang South Road No. 291, Jinnan District, Tianjin, 300350 China
| | - YueCheng Hu
- Department of Cardiology, Tianjin Chest Hospital, Taierzhuang South Road No. 291, Jinnan District, Tianjin, 300350 China
| | - JingXia Zhang
- Department of Cardiology, Tianjin Chest Hospital, Taierzhuang South Road No. 291, Jinnan District, Tianjin, 300350 China
| | - YingYi Zhang
- Department of Cardiology, Tianjin Chest Hospital, Taierzhuang South Road No. 291, Jinnan District, Tianjin, 300350 China
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13
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Shen Y, Dai Y, Wang XQ, Zhang RY, Lu L, Ding FH, Shen WF. Searching for optimal blood pressure targets in type 2 diabetic patients with coronary artery disease. Cardiovasc Diabetol 2019; 18:160. [PMID: 31733658 PMCID: PMC6858977 DOI: 10.1186/s12933-019-0959-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Controversies exist regarding the optimal blood pressure (BP) level that is safe and provides cardiovascular protection in patients with type 2 diabetes mellitus (T2DM) and coexistent coronary artery disease. Several new glucose-lowering agents have been found to lower BP as well, making the interaction between BP and T2DM even more complex. METHODS With the reference to recent literature, this review article describes the potential mechanisms of increased risk of hypertension in T2DM and outlines the possible optimal BP levels based upon recommendations on the management of hypertension by the current guidelines, in combination with our research findings, for type 2 diabetic patients with coronary artery disease. RESULTS The development of hypertension in T2DM involves multiple processes, including enhanced sympathetic output, inappropriate activation of renin-angiotensin- aldosterone system, endothelial dysfunction induced through insulin resistance, and abnormal sodium handling by the kidney. Both AGE-RAGE axis and adipokine dysregulation activate intracellular signaling pathways, increase oxidative stress, and aggravate vascular inflammation. Pancreatic β-cell specific microRNAs are implicated in gene expression and diabetic complications. Non-pharmacological intervention with lifestyle changes improves BP control, and anti-hypertensive medications with ACEI/ARB, calcium antagonists, β-blockers, diuretics and new hypoglycemic agent SGLT2 inhibitors are effective to decrease mortality and prevent major adverse cardiovascular events. For hypertensive patients with T2DM and stable coronary artery disease, control of BP < 130/80 mmHg but not < 120/70 mmHg is reasonable, whereas for those with chronic total occlusion or acute coronary syndromes, an ideal BP target may be somewhat higher (< 140/90 mmHg). Caution is advised with aggressive lowering of diastolic BP to a critical threshold (< 60 mmHg). CONCLUSIONS Hypertension and T2DM share certain similar aspects of pathophysiology, and BP control should be individualized to minimize adverse events and maximize benefits especially for patients with T2DM and coronary artery disease.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yang Dai
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
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14
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Lu H, Tang B, Zhou Y, Xu C, Bundhun PK, Tang Z, Bao H. Short-Term Versus Long-Term Adverse Cardiovascular Outcomes Post Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Simple Meta-Analysis. Diabetes Ther 2019; 10:1487-1497. [PMID: 31256352 PMCID: PMC6612339 DOI: 10.1007/s13300-019-0656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a major health issue, especially in patients with coexisting coronary artery disease (CAD). Patients with insulin-treated T2DM (ITDM) have worse outcomes than those with non-insulin-treated T2DM. Very few studies have compared short-term to long-term adverse cardiovascular outcomes following percutaneous coronary intervention (PCI) in patients on insulin therapy. Therefore, in this meta-analysis, we systematically compared short-term to long-term adverse cardiovascular outcomes in a population of patients with ITDM following PCI. METHODS We searched for English-language publications focusing on PCI in patients with ITDM using specific search terms/phrases. All the participants accepted for inclusion in this meta-analysis were treated with a drug-eluting stent. Post-intervention adverse cardiovascular outcomes observed during short-term and long-term follow-up periods were assessed and compared. Statistical analysis was carried out using the popular RevMan 5.3 software. Odd ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS Six studies comprising 1568 participants with ITDM in total were included in this simple meta-analysis. Patient enrollment periods varied but enrollment occurred during the years 1993-2012. When a fixed-effects statistical model was used, post-PCI adverse cardiovascular outcomes-such as major adverse cardiac events (MACEs) (OR 3.33, 95% CI 2.64-4.21; P = 0.00001), all-cause mortality (OR 5.73, 95% CI 3.37-9.73; P = 0.00001), myocardial infarction (MI) (OR 1.47, 95% CI 1.05-2.07; P = 0.02), and repeated revascularization (OR 4.78, 95% CI 3.29-6.94; P = 0.00001)-were found to be significantly more likely during the long-term follow-up period. A similar result was observed with a random-effects statistical model. CONCLUSION Adverse cardiovascular outcomes post PCI were significantly more likely during the long-term follow-up period than during the short-term follow-up period in these patients with T2DM on insulin therapy. This hypothesis requires confirmation via new comparative trials that consider short-term and long-term follow-up periods.
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Affiliation(s)
- Hongtao Lu
- Department of Cardiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Bing Tang
- Department of Cardiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Yanhua Zhou
- Department of Hematology, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Chenhong Xu
- Department of Cardiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Pravesh Kumar Bundhun
- Department of Internal Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Zhangui Tang
- Department of Cardiovascular Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Hong Bao
- Jiangling County People's Hospital of Cardiology, Jingzhou, Hubei, People's Republic of China.
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Kogan A, Ram E, Levin S, Fisman EZ, Tenenbaum A, Raanani E, Sternik L. Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery. Cardiovasc Diabetol 2018; 17:151. [PMID: 30497472 PMCID: PMC6264047 DOI: 10.1186/s12933-018-0796-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background Type 2 diabetes mellitus (DM) is a frequent co-morbidity among patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to evaluate the impact of DM on the early- and long-term outcomes of patients who underwent isolated CABG. Methods We performed an observational cohort study in a large tertiary medical center over a period of 11 years. All data from patients who had undergone isolated CABG surgery between 2004 and 2014 were obtained from our departmental database. The study population included 2766 patients who were divided into two groups: Group I (1553 non-diabetic patients), and Group II (1213 patients suffering from type 2 DM). Group II patients were then divided into two subgroups: subgroup IIA (981 patients treated with oral antihyperglycemic medications) and subgroup IIB (232 insulin-treated patients with or without additional oral antihyperglycemic drugs). In-hospital, 1-, 3-, 5- and 10-year mortality outcome variables were evaluated. Mean follow-up was 97 ± 41 months. Results In-hospital mortality was similar between Group I and Group II patients (1.87% vs. 2.31%, p = 0.422) and between the subgroups IIA and IIB (2.14% vs. 3.02%, p = 0.464). Long-term mortality (1, 3, 5 and 10 years) was higher in Group II (DM type 2) compared with Group I (non-diabetic patients) (5.3% vs. 3.6%, p = 0.038; 9.3% vs. 5.6%, p < 0.001; 15.3% vs. 9.3%, p < 0.001 and 47.3% vs. 29.6% p < 0.001). Kaplan–Meier analysis demonstrated that all-cause mortality was higher in Group II compared with Group I (p < 0.001) and in subgroup IIB compared with subgroup IIA (p = 0.001). Multivariable analysis showed that DM increased the mortality hazard by twofold, and among diabetic patients, insulin treatment increased the mortality hazard by twofold. Conclusions Diabetic and non-diabetic patients have similar in-hospital mortality rates. Survival rates of diabetic patients start to deteriorate 3 year after surgery. Type 2 DM is an independent predictor for long-term mortality after isolated CABG surgery. Mortality is even higher when the diabetes treatment strategy included insulin. Electronic supplementary material The online version of this article (10.1186/s12933-018-0796-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Kogan
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, 52621, Tel Aviv, Israel. .,Cardiac Surgery Intensive Care Unit, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Tel Aviv University, Tel Aviv, Israel.
| | - Eilon Ram
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, 52621, Tel Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Shany Levin
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, 52621, Tel Aviv, Israel
| | | | | | - Ehud Raanani
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, 52621, Tel Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, 52621, Tel Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
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16
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Iribarne A, DiScipio AW, Leavitt BJ, Baribeau YR, McCullough JN, Weldner PW, Huang YL, Robich MP, Clough RA, Sardella GL, Olmstead EM, Malenka DJ. Comparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention in a real-world Surgical Treatment for Ischemic Heart Failure trial population. J Thorac Cardiovasc Surg 2018; 156:1410-1421.e2. [DOI: 10.1016/j.jtcvs.2018.04.121] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 02/06/2023]
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17
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Dai X, Luo ZC, Zhai L, Zhao WP, Huang F. Reassessing Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients with Type 2 Diabetes Mellitus: A Brief Updated Analytical Report (2015-2017). Diabetes Ther 2018; 9:2163-2171. [PMID: 30220039 PMCID: PMC6167293 DOI: 10.1007/s13300-018-0504-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In this analysis, we aimed to systematically compare percutaneous coronary intervention (PCI) versus coronary artery bypass surgery (CABG) in terms of adverse outcomes utilizing data from a recent (2015-2017) population of patients with type 2 diabetes mellitus (T2DM). METHODS An electronic search of recent studies (2015-2017) was carried out using 'diabetes mellitus,' 'coronary artery bypass surgery,' and 'percutaneous coronary intervention' as the main search terms. Uncomplicated T2DM patients with stable coronary artery disease (CAD), left main CAD, and multi-vessel disease were included. RevMan software (version 5.3) was used to calculate odds ratios (OR) and 95% confidence intervals (CIs). RESULTS Among a total of 13,114 T2DM patients, CABG and PCI patients did not differ significantly in their rates of mortality (OR 0.90, 95% CI 0.61-1.31; P = 0.57) and cardiac death (OR 1.00, 95% CI 0.78-1.30; P = 0.98). However, rates of major adverse events, repeat revascularization, and myocardial infarction were significantly higher in the PCI group. Stroke rates did not significantly differ between the two groups. CONCLUSION Mortality (1-5 years) did not significantly differ between the CABG and PCI patients with T2DM. However, rates of other major adverse events were significantly higher in the PCI patients, suggesting that CABG is more advantageous than PCI in patients with T2DM.
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Affiliation(s)
- Xia Dai
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Zu-Chun Luo
- Department of Internal Medicine Education, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Lu Zhai
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Wen-Piao Zhao
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Feng Huang
- Institute of Cardiovascular Diseases and Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Disease Control and Prevention and Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
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19
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Neverova YN, Tarasov RS, Nagirnyak OA. Main predictors of in-hospital adverse outcomes in non-ST elevation acute coronary syndrome patients with multivessel disease. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-4-19-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To evaluate the range of risk factors associated with adverse cardiovascular events onset in hospital period of follow-up in patients with non-ST elevation acute coronary syndrome (NSTEACS) with multivessel disease (MD).Material and methods. To the study, under the framework of prospective, single-center registry, the NSTEACS and MD patients were included. Depending on the strategy of revascularization, three groups were selected: staged PCI, coronary bypass (CBG) and PCI as the first with CBG as the second stage. As adverse cardiovascular events, the following were taken: death, myocardial infarction, stroke or transient cerebral ishemia, clinically significant bleeding by BARC, repeat nonscheduled revascularization of target vessel. Results. Analysis revealed the groups of factors increasing the probability of adverse cardiovascular events. Those are: (1) clinical and demographic — older age, diabetes, postinfarction cardiosclerosis, multifocal atherosclerosis, chronic renal failure; (2) coronary and surgical — left main stem lesion, severe atherosclerosis by SYNTAX Score, high surgical risk by EuroScore II, revascularization strategy; (3) predominance of low or moderate risk by GRACE comparing with high risk.Conclusion. The results have confirmed high predictional significance of clinical and demography and coronary factors for development of adverse cardiovascular diseases. A significant finding of the study was the fact that in a hospital with surgery and endovascular treatment available 24/7, the intermediate and low GRACE risk in NSTEACS and MD is a factor of adverse cardiovascular events development due to revascularization delays if the risk is not high.
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Affiliation(s)
- Yu. N. Neverova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - R. S. Tarasov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. A. Nagirnyak
- Research Institute for Complex Issues of Cardiovascular Diseases
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Outcomes in Patients with Diabetes Mellitus According to Insulin Treatment After Percutaneous Coronary Intervention in the Second-Generation Drug-Eluting Stent Era. Am J Cardiol 2018; 121:1505-1511. [PMID: 29751955 DOI: 10.1016/j.amjcard.2018.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 11/22/2022]
Abstract
Limited data exist regarding the clinical outcomes of patients with diabetes mellitus (DM) after percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES), especially according to DM treatment. The purpose of this study was to compare clinical outcomes among patients without DM, with non-insulin-treated DM (non-ITDM), and with ITDM after PCI using second-generation DES. We analyzed 4,812 consecutive patients who underwent PCI using second-generation DES. Primary outcomes were patient-oriented composite outcome (a composite of all-cause mortality, any myocardial infarction, and any revascularization) at 3 years. Among the total population, 3,026 patients have no DM, 1,169 have non-ITDM, and 617 have ITDM. Patients with DM, regardless of non-ITDM and ITDM, showed significantly higher risk of patient-oriented composite outcome (21.0% vs 14.5%; adjusted hazard ratio [HRadj]1.41, 95% confidence interval [CI] 1.19 to 1.66, p <0.001), mainly driven by significantly higher risk of cardiac death and any revascularization compared with non-DM. Among DM population, ITDM showed significantly higher risk of cardiac death (7.7% vs 3.7%; HRadj 1.97, 95% CI 1.19 to 3.27, p = 0.009), any revascularization (17.0% vs 11.4%; HRadj 1.40, 95% CI 1.01 to 1.93, p = 0.041), and definite/probable stent thrombosis (1.7% vs 0.7%; HRadj 2.80, 95% CI 1.04 to 7.56, p = 0.042) compared with non-ITDM. In conclusion, even in the era of second-generation DES, patients with DM are at significantly higher risk of patient-oriented adverse events. Among these, patients with ITDM showed the highest risk of adverse events, mainly driven by higher risk of mortality, any revascularization, and definite/probable stent thrombosis.
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Abstract
PURPOSE OF REVIEW To provide an update on the management of patients with diabetes mellitus and requiring coronary revascularization. RECENT FINDINGS Evidence continues to show that patients with diabetes mellitus and ischemic heart disease represent a very high-risk group of patients. Choice of stent appears important for minimizing target lesion and target vessel adverse events with everolimus eluting stents having the best performance, particularly in patients being treated with insulin. The higher risk of adverse angioplasty results in patients with diabetes appears most related to the disease state per se and not necessarily to anatomical complexities. Interestingly, physiologic documentation of nonischemia producing lesions with use of fractional flow reserve appears less reassuring in this setting of aggressive and rapid atherosclerosis progression, particularly if myocardial infarction has occurred previously, than in patients without diabetes. Coronary artery bypass surgery in patients with appropriate anatomy and diabetes continues to emerge in many analyzes as the optimal, long-term therapy. IMPLICATIONS The treatment of diabetes per se, advances in stent technology and optimization of coronary artery bypass techniques are all occurring in parallel making it very critical for the design of modern era trials that keep pace with these advances. Currently, in patients with appropriate anatomy who are willing candidates, bypass surgery remains the optimal, long-term therapeutic option.
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Shen Y, Yang ZK, Hu J, Wang XQ, Dai Y, Zhang S, Zhang RY, Lu L, Ding FH, Shen WF. Donor artery stenosis interactions with diastolic blood pressure on coronary collateral flow in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2018; 17:76. [PMID: 29859086 PMCID: PMC5984405 DOI: 10.1186/s12933-018-0724-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/26/2018] [Indexed: 12/12/2022] Open
Abstract
Background We investigated whether and to what extent stenosis of predominant collateral donor artery (PCDA) affects coronary collateral flow in relation to blood pressure (BP) in type 2 diabetic patients with chronic total occlusion (CTO). Methods Collateral flow index (CFI) as derived from intracoronary pressure distal to occluded segment and mean aortic pressure in 220 type 2 diabetic patients and 220 propensity score matched non-diabetic controls undergoing percutaneous coronary intervention for CTO. The severity of PCDA stenosis was graded according to lumen diameter narrowing. Results CFI decreased stepwise from mild to severe stenosis of the PCDA and was lower in diabetic patients with moderate or severe PCDA stenosis than in non-diabetic controls (0.36 ± 0.10 vs. 0.45 ± 0.08, P < 0.001; 0.29 ± 0.09 vs. 0.35 ± 0.08, P = 0.008). When the PCDA was mildly stenotic, CFI increased initially along with a reduction in diastolic BP, and decreased when diastolic BP was below 60 mmHg in diabetic patients (0.38 ± 0.16 vs. 0.57 ± 0.09, P < 0.001). In the presence of moderate PCDA stenosis, diabetic patients had significantly lower CFI compared to non-diabetic controls, with a relative reduction of 19.8% at diastolic BP 70–79 mmHg, 28.2% at 60–69 mmHg and 38.2% below 60 mmHg (all P < 0.05). A severe PCDA stenosis resulted in a more pronounced decrease in CFI, with a relative reduction of 37.3% for diabetics compared to non-diabetics when diastolic BP was below 60 mmHg (P = 0.050). Conclusions In the setting of CTO, donor artery stenosis confers greater risk for reduced coronary collateral flow when diastolic BP is decreased. Even a moderate stenosis in the PCDA may be associated with lower collateral flow as diastolic BP decreases below 80 mmHg in type 2 diabetic than in non-diabetic patients.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Zhen Kun Yang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Jian Hu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Yang Dai
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Su Zhang
- College of Biomedical Engineering, Jiao Tong University, Shanghai, 200031, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.,Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
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23
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Wang Q, Liu H, Ding J. Cardiac Versus Non-Cardiac Related Mortality Following Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Meta-Analysis. Diabetes Ther 2018; 9:1335-1345. [PMID: 29779197 PMCID: PMC5984945 DOI: 10.1007/s13300-018-0444-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cardiovascular mortality is a major concern for patients with type 2 diabetes mellitus (T2DM). Insulin therapy significantly contributes to a high rate of death in these patients. We have performed a meta-analysis comparing cardiac and non-cardiac-related mortality following percutaneous coronary intervention (PCI) in a sample of patients with insulin-treated type 2 diabetes mellitus (ITDM). METHODS Studies were included in the meta-analysis if: (1) they were trials or cohort studies involving patients with T2DM post-PCI; (2) the outcomes in ITDM were separately reported; and (3) they reported cardiac death and non-cardiac death among their clinical endpoints. ITDM patients with any degree of coronary artery disease were included. The analysis was carried out using RevMan version 5.3 software, and data were reported with odds ratios (OR) and 95% confidence intervals (CI) as the main parameters. RESULTS A total of 4072 participants with ITDM were included, of whom 1658 participants and 2414 participants were extracted from randomized controlled trials and observational cohorts, respectively. Analysis of all data showed that death due to cardiac causes was significantly higher in patients with ITDM (OR 2.16, 95% CI 1.79-2.59; P = 0.00001). At 1 year of follow-up, cardiac death was still significantly higher compared to non-cardiac death (OR 2.39, 95% CI 1.47-3.88; P = 0.0004), and this result did not change with a longer follow-up period (3-5 years) (OR 2.09, 95% CI 1.70-2.56; P = 0.00001). Death due to cardiac causes was still significantly higher in the subpopulations of patients with everolimus-eluting stents (OR 2.31, 95% CI 1.26-4.26; P = 0.007), paclitaxel-eluting stents (OR 2.36, 95% CI 1.63-3.39; P = 0.00001), sirolimus-eluting stents (OR 2.11, 95% CI 1.67-2.67; P = 0.00001), and zotarolimus-eluting stents (OR 2.12, 95% CI 1.11-4.05; P = 0.02), respectively. CONCLUSIONS Mortality due to cardiac causes was significantly higher than that due to non-cardiac causes in patients with ITDM who had undergone PCI. The same conclusion could be drawn from analyses focused on different follow-up periods, types of coronary stents, and type of study data used.
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Affiliation(s)
- Qiang Wang
- Institute of Cardiovascular Diseases, Yichang Central People's Hospital, Yichang, 443000, Hubei, People's Republic of China
| | - Hao Liu
- Institute of Cardiovascular Diseases, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Jiawang Ding
- Institute of Cardiovascular Diseases, Yichang Central People's Hospital, Yichang, 443000, Hubei, People's Republic of China.
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Shen Y, Ding FH, Dai Y, Wang XQ, Zhang RY, Lu L, Shen WF. Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2018; 17:26. [PMID: 29422093 PMCID: PMC5804044 DOI: 10.1186/s12933-018-0671-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The extent of coronary collateral formation is a primary determinant of the severity of myocardial damage and mortality after coronary artery occlusion. Type 2 diabetes mellitus (T2DM) represents an important risk factor for impaired collateral vessel growth. However, the mechanism of reduced coronary collateralization in type 2 diabetic patients remains unclear. METHODS With the reference to the recent researches, this review article describes the pathogenic effects of T2DM on collateral development and outlines possible clinical and biochemical markers associated with reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion (CTO). RESULTS Diffuse coronary atherosclerosis in T2DM reduces pressure gradient between collateral donor artery and collateral recipient one, limiting collateral vessel growth and function. An interaction between advanced glycation end-products and their receptor activates several intracellular signaling pathways, enhances oxidative stress and aggravates inflammatory process. Diabetic condition decreases pro-angiogenic factors especially vascular endothelial growth factor and other collateral vessel growth related parameters. Numerous clinical and biochemical factors that could possibly attenuate the development of coronary collaterals have been reported. Increased serum levels of glycated albumin, cystatin C, and adipokine C1q tumor necrosis factor related protein 1 were associated with poor coronary collateralization in type 2 diabetic patients with stable coronary artery disease and CTO. Diastolic blood pressure and stenosis severity of the predominant collateral donor artery also play a role in coronary collateral formation. CONCLUSIONS T2DM impairs collateral vessel growth through multiple mechanisms involving arteriogenesis and angiogenesis, and coronary collateral formation in patients with T2DM and CTO is influenced by various clinical, biochemical and angiographic factors. This information provides insights into the understanding of coronary pathophysiology and searching for potential new therapeutic targets in T2DM.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Yang Dai
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 People’s Republic of China
- Institute of Cardiovascular Disease, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025 People’s Republic of China
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Orbach A, Halon DA, Jaffe R, Rubinshtein R, Karkabi B, Flugelman MY, Zafrir B. Impact of diabetes and early revascularization on the need for late and repeat procedures. Cardiovasc Diabetol 2018; 17:25. [PMID: 29402330 PMCID: PMC5798191 DOI: 10.1186/s12933-018-0669-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
Abstract
Background Coronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear. Methods Coronary angiography was performed in 12,420 patients between the years 2000–2015 and early revascularization status [none, percutaneous coronary intervention (PCI) or bypass surgery (CABG)] was determined. Subsequent revascularization procedures were recorded over a median follow-up of 67 months and its relation to diabetic and baseline revascularization status was studied. Results Early revascularization status was none in 5391, PCI in 5682 and CABG in 1347 patients. Late revascularization rates were 10, 26 and 11.1% respectively. Diabetes was present in 37%; a stepwise relationship of diabetic status with late revascularization was observed: no diabetes (reference) 14.4%, non-insulin treated diabetes 21% (adjusted HR 1.35, 95% CI 1.23–1.49, p < 0.001) and insulin-treated diabetes 32.8% (adjusted HR 2.20, 95% CI 1.91–2.54, p < 0.001), which was similar in magnitude for each early revascularization state (none, PCI or CABG). Further revascularizations (≥ 2) were also significantly more common in diabetics, in particular if insulin-treated. Glycosylated hemoglobin level was moderately associated with late revascularization in diabetics after early PCI but not following diagnostic catheterization or CABG. Conclusions Diabetic status graded by treatment, and in particular insulin therapy, is a strong predictor for late or repeat revascularization irrespective of early revascularization status. The high rate of repeat revascularization in diabetics following PCI remains a challenging issue. Electronic supplementary material The online version of this article (10.1186/s12933-018-0669-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ady Orbach
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel
| | - David A Halon
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Jaffe
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Rubinshtein
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Basheer Karkabi
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel
| | - Moshe Y Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel.
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Wang Y, Wen M, Zhou J, Chen Y, Zhang Q. Coronary artery bypass grafting versus percutaneous coronary intervention in patients with noninsulin treated type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. Diabetes Metab Res Rev 2018; 34. [PMID: 28921837 DOI: 10.1002/dmrr.2951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The outcomes and prognosis of revascularization by either coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) in patients with noninsulin-treated type 2 diabetes mellitus (NITDM) have not yet been well established. METHODS Randomized controlled trials (RCTs) were identified by searching Pubmed, EMBASE, and Cochrane library from inception until May 2016. Heterogeneity was evaluated, and the pooled hazard ratio (HR) was calculated by using a fixed-effect model. A random-effect model was used when statistically significant heterogeneity was observed (I2 ≥ 50%). All data analyses were carried out by using RevMan 5.3 and STATA software 12.0. RESULTS A total of 4 RCTs involving 5 studies, consisting of 2270 patients with noninsulin-treated type 2 diabetes mellitus, were identified. Compared with CABG-treated patients, PCI-treated patients had significantly higher all-cause mortality (HR 1.39; 95% CI 1.01 to 1.91; P = .04), myocardial infarction (HR 2.14; 95% CI 1.40 to 3.27; P = .0004), repeated revascularization (HR 2.52; 95% CI 1.77 to 3.57; P < .00001), and major adverse cardiovascular and cerebrovascular events (HR 1.50; 95% CI 1.20-1.87; P = .0004). However, PCI was associated with lower incidence of stoke (HR 0.47; 95% CI 0.24 to 0.90; P = .02). CONCLUSIONS In NITDM patients, our study suggests that CABG surgery is associated with reduced risk of mortality and morbidity, although with increased incidence of stroke compared with percutaneous coronary intervention. The decision if to have percutaneous coronary intervention or CABG surgery should factor the risk for stroke of the patients when considering CABG over percutaneous coronary intervention. Adequately powered RCTs are needed to confirm the results of this meta-analysis.
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Affiliation(s)
- Yushu Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Meiqin Wen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Junteng Zhou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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de Miguel-Yanes JM, Jiménez-García R, Hernández-Barrera V, Méndez-Bailón M, de Miguel-Díez J, Lopez-de-Andrés A. Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002-2014). Cardiovasc Diabetol 2017; 16:126. [PMID: 29017514 PMCID: PMC5635492 DOI: 10.1186/s12933-017-0609-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/03/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients. METHODS Retrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year. RESULTS We selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for "all cardiovascular events combined", than non-diabetic matched controls. CONCLUSIONS The number of hospital admissions for stroke, aortic aneurysm and dissection and acute lower limb ischemia increased overtime, but remained stable for myocardial infarction. T2DM is associated to higher IHM after major cardiovascular events. Further research is needed to help us understand the reasons for an apparently increased mortality in T2DM patients when admitted to hospital for some major cardiovascular events.
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Affiliation(s)
- José M. de Miguel-Yanes
- Medicine Department, Hospital Universitario Gregorio Marañon, Madrid, Comunidad De Madrid Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922 Alcorcon, Madrid, Comunidad De Madrid Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922 Alcorcon, Madrid, Comunidad De Madrid Spain
| | - Manuel Méndez-Bailón
- Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Comunidad De Madrid Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital Universitario Gregorio Marañon, Madrid, Comunidad De Madrid Spain
| | - Ana Lopez-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922 Alcorcon, Madrid, Comunidad De Madrid Spain
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Bundhun PK, Bhurtu A, Huang F. Worse clinical outcomes following percutaneous coronary intervention with a high SYNTAX score: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7140. [PMID: 28614240 PMCID: PMC5478325 DOI: 10.1097/md.0000000000007140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) score is an angiographic tool which is used to determine the complexity of coronary artery disease (CAD). We aimed to compare PCI versus coronary artery bypass surgery (CABG) in patients with a high SYNTAX score in order to confirm with evidence whether the former is really association with worse clinical outcomes. METHODS The National database of medical research articles (MEDLINE/PubMed), EMBASE database, and the Cochrane library were searched for publications comparing PCI versus CABG in patients with a high SYNTAX score, respectively. Death, myocardial infarction (MI), stroke, repeated revascularization, and a combined outcome death/stroke/MI were considered as the clinical endpoints. RevMan software was used to analyze the data, whereby odds ratios (OR) with 95% confidence intervals (CI) were used as the statistical parameters. RESULTS A total number of 1074 patients were included (455 patients with a high SYNTAX score were classified in the PCI group and 619 other patients with a high SYNTAX score were classified in the CABG group). A SYNTAX score cut-off value of ≥33 was considered relevant. Compared with CABG, mortality was significantly higher with a high SYNTAX score following PCI with OR: 1.79, 95% CI: 1.18 to 2.70; P = .006, I = 0%. The combined outcome death/stroke/MI was also significantly higher following PCI with a high SYNTAX score, with OR: 1.69, 95% CI: 1.24 to 2.30; P = .0009, I = 0%. In addition, PCI was also associated with significantly higher MI and repeated revascularization when compared with CABG, with OR: 3.72, 95% CI: 1.75 to 7.89; P = .0006, I = 0% and OR: 4.33, 95% CI: 1.71 to 10.94; P = .002, I = 77%, respectively. However, stroke was not significantly different. CONCLUSIONS Compared with CABG, worse clinical outcomes were observed following PCI in patients with a high SYNTAX score, confirming with evidence, published clinical literatures. Therefore, CABG should be recommended to CAD patients who have been allotted a high SYNTAX score.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University
| | - Akash Bhurtu
- Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Feng Huang
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University
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Birkner K, Hudzik B, Gąsior M. The impact of type 2 diabetes mellitus on prognosis in patients with non-ST elevation myocardial infarction. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2017; 14:127-132. [PMID: 28747945 PMCID: PMC5519839 DOI: 10.5114/kitp.2017.68744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 04/18/2017] [Indexed: 06/07/2023]
Abstract
Type 2 diabetes (T2D) is a recognized risk factor for acute coronary syndromes. There is currently no consensus concerning the intensification of antihyperglycemic treatment. According to the available guidelines, it seems that the goal is to achieve glycated hemoglobin (HbA1c) levels below 7% and avoid hypoglycemia. The choice of a revascularization method is influenced by many factors, such as the anatomy of the coronary arteries, severity of atherosclerosis, anatomical location of lesions, and presence of comorbidities. However, in non-ST elevation myocardial infarction, determining the culprit lesion is often difficult based on ECG or angiography. Experts recommend coronary artery bypass grafting (CABG) in patients with type 2 diabetes and multivessel or complex (SYNTAX score exceeding 22 points) coronary artery disease in order to improve survival. Percutaneous coronary intervention should be considered as an alternative to CABG to control symptoms in patients with type 2 diabetes and less complex forms of the disease (i.e., SYNTAX score of 22 or lower).
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Affiliation(s)
- Katarzyna Birkner
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease in Zabrze, Poland
| | - Bartosz Hudzik
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease in Zabrze, Poland
| | - Mariusz Gąsior
- 3 Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease in Zabrze, Poland
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Bundhun PK, Bhurtu A, Yuan J. Impact of type 2 diabetes mellitus on the long-term mortality in patients who were treated by coronary artery bypass surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7022. [PMID: 28562555 PMCID: PMC5459720 DOI: 10.1097/md.0000000000007022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent scientific reports have mainly focused on the comparison between coronary artery bypass surgery (CABG) and percutaneous coronary intervention. However, the impact of type 2 diabetes mellitus (T2DM) on mortality in patients who were treated by CABG was often ignored. Therefore, we aimed to compare the long-term mortality following CABG in patients with and without T2DM. METHODS Studies comparing the long-term adverse outcomes following CABG in patients with and without T2DM were searched from electronic databases. Total number of deaths (primary outcome) and events of myocardial infarction (MI), major adverse cerebrovascular and cardiovascular events (MACCEs), stroke, and repeated revascularization (secondary outcomes) were carefully extracted. An analysis was carried out whereby odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the RevMan 5.3 software. RESULTS Eleven studies with a total number of 12,965 patients were included. Current results showed that mortality was significantly higher in patients with T2DM with OR: 1.54, 95% CI: 1.37 to 1.72, P < .00001; OR: 1.53, 95% CI: 1.36 to 1.72, P < .00001; and OR: 1.53, 95% CI: 1.26 to 1.87, P < .0001 at 1 to 15, 5 to 15, and 7 to 15 years, respectively. However, MI, repeated revascularization, MACCEs, and stroke were not significantly different with OR: 1.15, 95% CI: 0.81 to 1.64, P = .44; OR: 1.09, 95% CI: 0.88 to 1.36, P = .43; OR: 1.11, 95% CI: 0.83 to 1.48, P = .48; and OR: 1.69, 95% CI: 0.93 to 3.07, P = .08, respectively. CONCLUSION Following CABG, a significantly higher rate of mortality was continually observed in patients with T2DM compared to patients without T2DM showing that the former apparently has a high impact on the long-term mortality. However, even if T2DM is an independent risk factor for mortality, it should not be ignored that CABG remains the best revascularization strategy in these patients.
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Affiliation(s)
- Pravesh K. Bundhun
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Guangxi Medical University
| | | | - Jun Yuan
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, PR China
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Bezdenezhnykh NA, Sumin AN. Myocardial revascularization in patients with coronary heart disease and type 2 diabetes. DIABETES MELLITUS 2016. [DOI: 10.14341/dm7922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The review discusses myocardial revascularization in patients with coronary heart disease and type 2 diabetes. The data presented include findings from recent research and international and national recommendations and provides evidence on the advantages of coronary artery bypass surgery over percutaneous coronary intervention for patients with diabetes mellitus, stable coronary artery disease and multiple coronary artery lesions. Type 2 diabetes remains a significant predictor of adverse long-term outcomes of coronary artery bypass surgery. Therefore, we review studies showing that different strategies of coronary revascularization and preoperative preparation can affect the results of coronary intervention in patients with diabetes.
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Bundhun PK, Pursun M, Teeluck AR, Bhurtu A, Soogund MZS, Huang WQ. Adverse Cardiovascular Outcomes associated with Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention with Everolimus Eluting Stents: A Meta-Analysis. Sci Rep 2016; 6:35869. [PMID: 27775055 PMCID: PMC5075879 DOI: 10.1038/srep35869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/06/2016] [Indexed: 12/14/2022] Open
Abstract
This study aimed to compare the mid-term adverse cardiovascular outcomes associated with Coronary Artery Bypass Surgery (CABG) and Percutaneous Coronary Intervention (PCI) with Everolimus Eluting Stents (EES). Electronic databases were searched for studies comparing the mid-term (>1 year) adverse cardiovascular outcomes between CABG and PCI with EES. Odd Ratios (OR) with 95% Confidence Intervals (CIs) were calculated and the pooled analyses were performed with RevMan 5.3 software. A total number of 5207 patients were involved in this analysis. No significant difference was observed in mortality between CABG and EES with OR: 0.90, 95% CI: 0.73-1.10; P = 0.30. Moreover, CABG was associated with a high stroke rate, with OR: 0.73, 95% CI: 0.45-1.17; P = 0.19, without any statistical significant. CABG was associated with significantly lower Major Adverse Cardiac Events and Myocardial Infarction with OR: 1.46, 95% CI: 1.05-2.04; P = 0.03 and OR: 1.46, 95% CI: 1.01-2.12; P = 0.05 respectively whereas PCI was associated with a significantly higher repeated revascularization with OR: 2.21; 95% CI: 1.76-2.77; P = 0.00001. In conclusion, significant differences were noted in several subgroups analyzing the mid-term cardiovascular outcomes between CABG and EES.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, P. R. China
| | - Manish Pursun
- Guangxi Medical University, Nanning, Guangxi, 530027, P. R. China
| | | | - Akash Bhurtu
- Guangxi Medical University, Nanning, Guangxi, 530027, P. R. China
| | | | - Wei-Qiang Huang
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, P. R. China
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Medical Treatment and Revascularization Options in Patients With Type 2 Diabetes and Coronary Disease. J Am Coll Cardiol 2016; 68:985-95. [DOI: 10.1016/j.jacc.2016.06.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 05/03/2016] [Accepted: 06/05/2016] [Indexed: 12/22/2022]
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Munnee K, Bundhun PK, Quan H, Tang Z. Comparing the Clinical Outcomes Between Insulin-treated and Non-insulin-treated Patients With Type 2 Diabetes Mellitus After Coronary Artery Bypass Surgery: A Systematic Review and Meta-analysis. Medicine (Baltimore) 2016; 95:e3006. [PMID: 26962814 PMCID: PMC4998895 DOI: 10.1097/md.0000000000003006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Several studies have shown coronary artery bypass surgery (CABG) to be beneficial in patients with type 2 diabetes mellitus (T2DM) and multivessel coronary artery diseases. Patients with insulin-treated T2DM (ITDM) are usually patients with poor glycemic control and are expected to suffer more complications compared with patients with non-insulin-treated T2DM (NITDM). However, the adverse clinical outcomes in patients with ITDM and NITDM after CABG are still not very clear. Hence, to solve this issue, we aim to compare the short-and long-term adverse clinical outcomes in a larger number of patients with ITDM and NITDM after CABG, respectively.Randomized controlled trials and observational studies comparing the adverse clinical outcomes such as mortality, major adverse events (MAEs), stroke, myocardial infarction, and repeated revascularization in patients with ITDM and NITDM after CABG have been searched from Medline, EMBASE, Cochrane, and PubMed databases. A short-term follow-up (≤30 days) and a long-term follow-up (≥1 year) were considered. Odds ratio (OR) with 95% confidence interval (CI) was used to express the pooled effect on discontinuous variables and the pooled analyses were performed with RevMan 5.3.Eleven studies involving a total of 64,152 patients with T2DM (23,781 patients with ITDM and 40,371 patients with NITDM) have been included in this meta-analysis. During the short-term follow-up period, patients with ITDM had a significantly higher mortality (OR: 1.47; 95% CI: 1.33-1.61, P < 0.00001) and MAEs (OR: 1.66; 95% CI: 1.48-1.87, P < 0.00001). During the long-term follow-up period, patients with ITDM still had a significantly higher rate of mortality, MAEs, and stroke (OR: 1.23, 95% CI: 1.02-1.49, P = 0.03; OR: 1.50, 95% CI: 1.07-2.12, P = 0.02; OR: 1.39, 95% CI: 1.22-1.59, P < 0.00001, respectively) after CABG. However, our results showed similar repeated revascularization rate between the ITDM and NITDM groups after CABG (OR: 1.31, 95% CI: 0.81-2.12, P = 0.27).According to this study, patients with ITDM had a significantly higher rate of mortality and MAEs compared with patients with NITDM after CABG. Stroke was also significantly higher in patients with ITDM during a long-term follow-up period. However, since the result for the long-term mortality had a higher heterogeneity as compared with the other subgroups, and because a similar revascularization rate was observed between the ITDM and NITDM groups after CABG maybe because of a limited number of patients analyzed, further studies still need to be conducted to completely solve this issue.
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Affiliation(s)
- Krishna Munnee
- From the Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, Hunan (KM, HQ, ZT, ); Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China (PKB)
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