Xueyan Zhao1, Lianjun Xu1, Lin Jiang1, Jian Tian1, Yin Zhang1, Dong Wang1, Kai Sun1, Bo Xu1, Wei Zhao1, Rutai Hui1, Runlin Gao1, Lei Song2, Jinqing Yuan3. 1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, China. 2. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, China. songlqd@126.com. 3. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, China. jqyuanfw@163.com.
Abstract
BACKGROUND: Patients with diabetes and triple-vessel disease (TVD) are associated with a high risk of events. The choice of treatment strategies remains a subject of discussion. In the real-world, we aim to compare the outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) treatment strategies in patients with diabetes and TVD. METHODS: A total of 3117 consecutive patients with diabetes and TVD were enrolled. The primary endpoint was all-cause death and the secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, or stroke). RESULTS: During the mean follow-up of 6.3 ± 2.6 years, 573 (18.4%) deaths and 1094 (35.1%) MACCE occurred. Multivariate analysis showed that PCI (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.32-0.51) and CABG (HR 0.33, 95% CI 0.26-0.44) were associated with a lower risk of death compared with MT, with no difference between the PCI and CABG groups. When MACCE was the endpoint, PCI (HR 0.71, 95% CI 0.60-0.84) and CABG (HR 0.48, 95% CI 0.39-0.57) had a lower risk than MT. CABG was associated with a significantly lower risk of MACCE compared with PCI (HR 0.67, 95% CI 0.55-0.81), which was mainly attributed a lower risk in myocardial infarction, but a higher risk of stroke. CONCLUSIONS: In this big real-world data and intermediate-term follow-up study, for patients with diabetes and TVD, PCI and CABG were associated with a lower risk of death and MACCE more than MT. The results suggest the importance of appropriate revascularization for diabetic patients with TVD. However, CABG was not associated with a lower risk of death, but with a lower risk of MACCE, compared with PCI. In the future, we perhaps should strengthen comprehensive treatment in addition to PCI or CABG.
BACKGROUND:Patients with diabetes and triple-vessel disease (TVD) are associated with a high risk of events. The choice of treatment strategies remains a subject of discussion. In the real-world, we aim to compare the outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) treatment strategies in patients with diabetes and TVD. METHODS: A total of 3117 consecutive patients with diabetes and TVD were enrolled. The primary endpoint was all-cause death and the secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, or stroke). RESULTS: During the mean follow-up of 6.3 ± 2.6 years, 573 (18.4%) deaths and 1094 (35.1%) MACCE occurred. Multivariate analysis showed that PCI (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.32-0.51) and CABG (HR 0.33, 95% CI 0.26-0.44) were associated with a lower risk of death compared with MT, with no difference between the PCI and CABG groups. When MACCE was the endpoint, PCI (HR 0.71, 95% CI 0.60-0.84) and CABG (HR 0.48, 95% CI 0.39-0.57) had a lower risk than MT. CABG was associated with a significantly lower risk of MACCE compared with PCI (HR 0.67, 95% CI 0.55-0.81), which was mainly attributed a lower risk in myocardial infarction, but a higher risk of stroke. CONCLUSIONS: In this big real-world data and intermediate-term follow-up study, for patients with diabetes and TVD, PCI and CABG were associated with a lower risk of death and MACCE more than MT. The results suggest the importance of appropriate revascularization for diabeticpatients with TVD. However, CABG was not associated with a lower risk of death, but with a lower risk of MACCE, compared with PCI. In the future, we perhaps should strengthen comprehensive treatment in addition to PCI or CABG.
Authors: Aidin Rawshani; Araz Rawshani; Stefan Franzén; Björn Eliasson; Ann-Marie Svensson; Mervete Miftaraj; Darren K McGuire; Naveed Sattar; Annika Rosengren; Soffia Gudbjörnsdottir Journal: N Engl J Med Date: 2017-04-13 Impact factor: 91.245
Authors: Franz-Josef Neumann; Miguel Sousa-Uva; Anders Ahlsson; Fernando Alfonso; Adrian P Banning; Umberto Benedetto; Robert A Byrne; Jean-Philippe Collet; Volkmar Falk; Stuart J Head; Peter Jüni; Adnan Kastrati; Akos Koller; Steen D Kristensen; Josef Niebauer; Dimitrios J Richter; Petar M Seferovic; Dirk Sibbing; Giulio G Stefanini; Stephan Windecker; Rashmi Yadav; Michael O Zembala Journal: Eur Heart J Date: 2019-01-07 Impact factor: 29.983
Authors: Michael E Farkouh; Michael Domanski; George D Dangas; Lucas C Godoy; Michael J Mack; Flora S Siami; Taye H Hamza; Binita Shah; Giulio G Stefanini; Mandeep S Sidhu; Jean-François Tanguay; Krishnan Ramanathan; Samin K Sharma; John French; Whady Hueb; David J Cohen; Valentin Fuster Journal: J Am Coll Cardiol Date: 2018-11-11 Impact factor: 24.094
Authors: Subodh Verma; Michael E Farkouh; Bobby Yanagawa; David H Fitchett; Muhammad R Ahsan; Marc Ruel; Sachin Sud; Milan Gupta; Shantanu Singh; Nandini Gupta; Asim N Cheema; Lawrence A Leiter; Paul W M Fedak; Hwee Teoh; David A Latter; Valentin Fuster; Jan O Friedrich Journal: Lancet Diabetes Endocrinol Date: 2013-09-13 Impact factor: 32.069
Authors: T M Hommels; R S Hermanides; S Rasoul; B Berta; A J J IJsselmuiden; G A J Jessurun; E Benit; B Pereira; G De Luca; E Kedhi Journal: Cardiovasc Diabetol Date: 2019-03-09 Impact factor: 9.951