Document Detail


Long-Term Outcome of Stents Versus Bypass Surgery in Diabetic and Nondiabetic Patients With Multivessel or Left Main Coronary Artery Disease: A Pooled Analysis of 5775 Individual Patient Data.
MedLine Citation:
PMID:  22872052     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: CORONARY ARTERY BYPASS GRAFTING AND PERCUTANEOUS CORONARY INTERVENTION (PCI) ARE ALTERNATIVE TREATMENTS FOR COMPLEX MULTIVESSEL OR LEFT MAIN DISEASE. HOWEVER, THE RELATIVE TREATMENT EFFECTS IN DIABETIC AND NONDIABETIC PATIENTS REMAIN UNCERTAIN.METHODS AND RESULTS: WE PERFORMED A POOLED ANALYSIS OF 5775 PATIENTS FROM 3 CLINICAL STUDIES COMPARING PCI AND CORONARY ARTERY BYPASS GRAFTING FOR MULTIVESSEL OR LEFT MAIN DISEASE AND COMPARED ADVERSE OUTCOMES (DEATH; A COMPOSITE OUTCOME OF DEATH, Q-WAVE MYOCARDIAL INFARCTION, OR STROKE; AND REPEAT REVASCULARIZATION) ACCORDING TO THE DIABETIC STATUS. OVER A MEDIAN FOLLOW-UP OF 5.5 YEARS, RISK-ADJUSTED MORTALITY AFTER PCI RELATIVE TO CORONARY ARTERY BYPASS GRAFTING WAS NOT DIFFERENT IN DIABETIC (HAZARD RATIO [HR], 1.15; 95% CI, 0.881.51) AND NONDIABETIC (HR, 1.15; 95% CI, 0.881.50) PATIENTS. THE ADJUSTED RISKS OF THE COMPOSITE OUTCOME OF DEATH, Q-WAVE MYOCARDIAL INFARCTION, OR STROKE WERE ALSO NOT DIFFERENT IN DIABETIC (HR, 1.00; 95% CI, 0.791.26) AND NONDIABETIC (HR, 0.99; 95% CI, 0.781.26) PATIENTS. HOWEVER, PCI WAS SIGNIFICANTLY ASSOCIATED WITH HIGHER RISK OF REPEAT REVASCULARIZATION BOTH IN DIABETIC (HR, 3.56; 95% CI, 2.624.83) AND IN NONDIABETIC (HR, 3.55; 95% CI, 2.614.83) PATIENTS. SIGNIFICANT INTERACTIONS WERE ABSENT BETWEEN DIABETIC STATUS AND REVASCULARIZATION STRATEGIES FOR DEATH (P=0.27), COMPOSITE OUTCOME OF DEATH, Q-WAVE MYOCARDIAL INFARCTION, OR STROKE (P=0.97), AND REPEAT REVASCULARIZATION (P=0.08).CONCLUSIONS: For multivessel or left main disease, the long-term risks of mortality and composite serious outcomes were not different between PCI and coronary artery bypass grafting in diabetic and nondiabetic patients, but PCI was associated with higher risk of repeat revascularization. These relative treatment effects were not modified by diabetic status. These results are hypothesis generating and should be addressed in a randomized trial.
Authors:
Duk-Woo Park; Young-Hak Kim; Hae Geun Song; Jung-Min Ahn; Won-Jang Kim; Jong-Young Lee; Soo-Jin Kang; Seung-Whan Lee; Cheol Whan Lee; Seong-Wook Park; Sung-Cheol Yun; Sung-Ho Chung; Suk Jung Choo; Cheol Hyun Chung; Jae-Won Lee; Seung-Jung Park
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-7
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Cardiology and Cardiac Surgery, and Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea.
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