Document Detail


Comparison of bilateral thoracic artery grafting with percutaneous coronary interventions in diabetic patients.
MedLine Citation:
PMID:  15276499     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This study compares the outcome of percutaneous coronary interventions (PCI) with bilateral internal thoracic grafting (BITA) in diabetic patients.
METHODS: From May 1996 to December 1999, 802 consecutive diabetic patients underwent myocardial revascularization: 363 by PCI and 439 by BITA. The two groups were similar; however, left main disease (28% versus 3.3%), ejection fraction less than 0.35 (14.5% versus 5.5%), and chronic obstructive lung disease (8.4% versus 3%) were more prevalent in the BITA group, and prior percutaneous transluminal coronary angioplasty, in the PCI group (16.8% versus 10.5%).
RESULTS: The number of coronary vessels treated per patient was higher in the BITA group (3.4 versus 1.2; p < 0.001). Thirty-day mortality was similar: 3.4% in the BITA group and 2.8% in the PCI group. Late follow-up (3 to 6.5 years) showed decreased return of angina (11% versus 64%; p < 0.001), fewer reinterventions (2.7% versus 55%; p < 0.001), and increased cardiovascular event-free survival (80% versus 30%; p < 0.001) in the BITA group. Six-year survival of BITA and PCI patients was 85.5% and 81.2%, respectively (not significant). However, survival of the subgroups of patients with left main or three-vessel coronary artery disease was significantly better with BITA (86% versus 76%; p = 0.003).
CONCLUSIONS: Despite higher risk profile of diabetic patients treated surgically by BITA, their late outcome is better than that of patients treated by PCI. The results of this study support referring diabetics with single-vessel or double-vessel disease to PCI and those with three-vessel and left main coronary artery disease to surgery.
Authors:
Chaim Locker; Rephael Mohr; Oren Lev-Ran; Gideon Uretzky; Aharon Frimerman; Yael Shaham; Itzhak Shapira
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Review    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  78     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-07-27     Completed Date:  2005-05-24     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  471-5; discussion 476     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6Tel Aviv 64239, Israel.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon
Angioplasty, Balloon, Coronary / statistics & numerical data*
Antibodies, Monoclonal / therapeutic use
Aspirin / therapeutic use
Combined Modality Therapy
Coronary Artery Bypass / methods,  statistics & numerical data*
Coronary Disease / complications,  drug therapy,  surgery*
Diabetes Complications / drug therapy,  surgery*
Diltiazem / therapeutic use
Female
Humans
Immunoglobulin Fab Fragments / therapeutic use
Isosorbide Dinitrate / therapeutic use
Life Tables
Male
Middle Aged
Peptides / therapeutic use
Platelet Aggregation Inhibitors / therapeutic use
Recurrence
Retrospective Studies
Stents
Survival Analysis
Thoracic Arteries / surgery*
Ticlopidine / therapeutic use
Treatment Outcome
Vascular Patency
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Peptides; 0/Platelet Aggregation Inhibitors; 0/eptifibatide; 42399-41-7/Diltiazem; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 87-33-2/Isosorbide Dinitrate; X85G7936GV/abciximab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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