Jeevan Nagendran1, Sabin J Bozso2, Colleen M Norris1, Finlay A McAlister3, Jehangir J Appoo4, Michael C Moon1, Darren H Freed5, Jayan Nagendran6. 1. Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada. 2. Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. 3. Division of General Internal Medicine and Patient Health Outcomes Research and Clinical Effectiveness Unit, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 4. Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada. 5. Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, Alberta, Canada. 6. Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, Alberta, Canada. Electronic address: jayan@ualberta.ca.
Abstract
BACKGROUND: The role of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) has been established by large trials; however, these trials largely excluded patients with left ventricular dysfunction (LVD). OBJECTIVES: The aim of this study was to determine whether treatment with PCI or CABG leads to improved outcomes in patients with DM, CAD, and LVD. METHODS: In this propensity-matched study, outcomes were compared for patients with CAD, DM, and LVD treated with PCI or CABG between 2004 and 2016. The primary outcome was major adverse cardiac and cerebrovascular events, defined as the composite of death, stroke, myocardial infarction, and repeat revascularization. Secondary outcomes were the individual components of the primary outcome. RESULTS: PCI compared with CABG was associated with a higher risk for major adverse cardiac and cerebrovascular events in cohorts with ejection fraction (EF) 35% to 49% (p < 0.001) and <35% (p < 0.001). Treatment with PCI was associated with an increased risk for death in both the EF 35% to 49% and the EF <35% cohorts. Stroke rate did not differ between PCI and CABG in either EF cohort. PCI was associated with an increased rate of MI in the EF <35% cohort, and repeat revascularization occurred more frequently in patients treated with PCI in both the EF 35% to 49% cohort and the EF <35% cohort. CONCLUSIONS: At long-term follow-up, patients with CAD, DM, and LVD treated with CABG exhibited a significantly lower incidence of major adverse cardiac and cerebrovascular events and better long-term survival over PCI, without a higher risk for stroke.
BACKGROUND: The role of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) has been established by large trials; however, these trials largely excluded patients with left ventricular dysfunction (LVD). OBJECTIVES: The aim of this study was to determine whether treatment with PCI or CABG leads to improved outcomes in patients with DM, CAD, and LVD. METHODS: In this propensity-matched study, outcomes were compared for patients with CAD, DM, and LVD treated with PCI or CABG between 2004 and 2016. The primary outcome was major adverse cardiac and cerebrovascular events, defined as the composite of death, stroke, myocardial infarction, and repeat revascularization. Secondary outcomes were the individual components of the primary outcome. RESULTS: PCI compared with CABG was associated with a higher risk for major adverse cardiac and cerebrovascular events in cohorts with ejection fraction (EF) 35% to 49% (p < 0.001) and <35% (p < 0.001). Treatment with PCI was associated with an increased risk for death in both the EF 35% to 49% and the EF <35% cohorts. Stroke rate did not differ between PCI and CABG in either EF cohort. PCI was associated with an increased rate of MI in the EF <35% cohort, and repeat revascularization occurred more frequently in patients treated with PCI in both the EF 35% to 49% cohort and the EF <35% cohort. CONCLUSIONS: At long-term follow-up, patients with CAD, DM, and LVD treated with CABG exhibited a significantly lower incidence of major adverse cardiac and cerebrovascular events and better long-term survival over PCI, without a higher risk for stroke.
Authors: Nadia Bouabdallaoui; Susanna R Stevens; Torsten Doenst; Mark C Petrie; Nawwar Al-Attar; Imtiaz S Ali; Andrew P Ambrosy; Anna K Barton; Raymond Cartier; Alexander Cherniavsky; Pierre Demondion; Patrice Desvigne-Nickens; Robert R Favaloro; Sinisa Gradinac; Petra Heinisch; Anil Jain; Marek Jasinski; Jerome Jouan; Renato A K Kalil; Lorenzo Menicanti; Robert E Michler; Vivek Rao; Peter K Smith; Marian Zembala; Eric J Velazquez; Hussein R Al-Khalidi; Jean L Rouleau Journal: Circ Heart Fail Date: 2018-11 Impact factor: 8.790
Authors: Qin Fan; Jun Liu; Yan Xu; Ruiqing Ni; Rui Xi; Fang Wang; Jian Hu; Hongyue Sun; Zhenkun Yang; Mi Zhou; Ruiyan Zhang; Qiang Zhao; Rong Tao Journal: Front Cardiovasc Med Date: 2021-06-24