Comparison of medium-term outcomes obtained with drug-eluting stents and coronary artery bypass grafts in an unselected population of diabetic patients with multivessel coronary disease. Propensity score analysis
| Autor: | Juan H. Alonso-Briales, José M. Hernández-García, Eduardo de Teresa-Galván, Inés Leruite-Martín, Antonio L. Linde-Estrella, Olga Pérez-González, Antonio J. Domínguez-Franco, Manuel F. Jiménez-Navarro, Eduardo Olalla-Mercadé |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Paclitaxel medicine.medical_treatment Coronary Disease Anterior Descending Coronary Artery Revascularization Cohort Studies Diabetes mellitus Internal medicine medicine Myocardial Revascularization Humans cardiovascular diseases Myocardial infarction Coronary Artery Bypass Stroke Aged Retrospective Studies Sirolimus business.industry Graft Occlusion Vascular Drug-Eluting Stents General Medicine Middle Aged medicine.disease Antineoplastic Agents Phytogenic Surgery medicine.anatomical_structure Logistic Models Treatment Outcome Drug-eluting stent Propensity score matching Cardiology Female business Diabetic Angiopathies Immunosuppressive Agents Artery |
| Zdroj: | Revista espanola de cardiologia. 62(5) |
| ISSN: | 1579-2242 |
| Popis: | Since the introduction of drug-eluting stents, the optimum revascularization strategy in diabetic patients with multivessel coronary disease has remained controversial.This study used multivariate logistic regression analysis and propensity score matching to compare results in 270 consecutive diabetic patients (2000-2004) with multivessel disease (or =2 vessels with a70% de novo stenosis involving the proximal left anterior descending coronary artery) who underwent either coronary artery bypass grafting (CABG; n=142) or implantation of a drug-eluting stent (DES; i.e. rapamycin or paclitaxel; n=128). The following clinical outcomes (i.e. major adverse cardiac or cerebrovascular events [MACCEs]) were assessed: death, nonfatal myocardial infarction (MI), stroke and repeat revascularization at 2 years.Patients who received DESs were older (67.5+/-7 years vs. 65.3+/-8 years; P=.05) and more often had a previous MI (49.2% vs. 28.2%; P.01), but no more often had a depressed left ventricular ejection fractionor =45% (32.4% vs. 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9+/-7 vs. 18.5+/-6; P.001) and the quality of revascularization was better (i.e. anatomically complete revascularization: 52.8% vs. 28.1%; P.01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] = 0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR = 1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs. 12.1%; adjusted OR = 0.42; 95% CI, 0.16-1.14; P=.09).In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke. |
| Databáze: | OpenAIRE |
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