Long-term outcomes after percutaneous coronary intervention relative to bypass surgery in diabetic patients with multivessel coronary artery disease according to clinical presentation
| Autor: | Myeong Ki Hong, Chul Min Ahn, Donghoon Choi, Jung Sun Kim, Yangsoo Jang, Byeong Keuk Kim, Yongsung Suh, Yong Joon Lee, Sanghoon Shin, Sung Jin Hong, Seunghwan Kim, Young Guk Ko |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Acute coronary syndrome medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Coronary Artery Disease 030204 cardiovascular system & hematology Revascularization Coronary artery disease 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Internal medicine Republic of Korea Diabetes Mellitus medicine Humans Angina Stable Angina Unstable cardiovascular diseases 030212 general & internal medicine Myocardial infarction Acute Coronary Syndrome Coronary Artery Bypass Mortality Non-ST Elevated Myocardial Infarction Propensity Score Aged Proportional Hazards Models business.industry Hazard ratio Percutaneous coronary intervention General Medicine Middle Aged medicine.disease Stroke Treatment Outcome surgical procedures operative Bypass surgery Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Coronary Artery Disease. 31:174-183 |
| ISSN: | 0954-6928 |
| DOI: | 10.1097/mca.0000000000000767 |
| Popis: | Background For diabetic patients with multivessel coronary artery disease (MVD), limited data exist on the long-term outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) according to clinical presentation [stable coronary artery disease (SCAD) or non-ST-elevation acute coronary syndrome (NSTE-ACS)]. Patients and methods From a Korean multicenter registry, we analyzed 1135 diabetic patients with MVD treated with PCI (n = 660) or CABG (n = 475). After propensity score matching, 8-year major adverse cardiovascular and cerebrovascular events [MACCE; composite of all-cause death, myocardial infarction (MI), or stroke] were compared between PCI and CABG according to clinical presentation. Results After matching, MACCE was not different between PCI and CABG for SCAD patients [15.6 vs. 17.2%, hazard ratio (HR) = 0.94, 95% confidence interval (CI) = 0.55-1.63, P = 0.837], whereas it was higher in PCI than in CABG for NSTE-ACS patients (31.1 vs. 22.4%, HR = 1.63, 95% CI = 1.03-2.59, P = 0.036), mainly driven by the higher MI occurrence (HR = 2.18, 95% CI = 1.04-4.59, P = 0.035). A significant interaction between revascularization strategy and clinical presentation was observed for MACCE (P-interaction = 0.022). However, when PCI was further classified according to revascularization completeness, the treatment gap between PCI and CABG with respect to MI in NSTE-ACS patients was improved by complete-revascularization PCI. Conclusion Among diabetic patients with MVD, the long-term outcomes of PCI versus CABG differed according to clinical presentation. CABG may be more beneficial for NSTE-ACS patients with MVD in reducing MACCE and MI, whereas PCI was as effective as CABG for SCAD patients with MVD. Therefore, clinical presentation must be considered when choosing revascularization strategies in these patients. |
| Databáze: | OpenAIRE |
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