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Medical Treatment and Revascularization Options in Patients With Type 2 Diabetes and Coronary Disease.
Mancini, G B John; Farkouh, Michael E; Brooks, Maria M; Chaitman, Bernard R; Boden, William E; Vlachos, Helen; Hartigan, Pamela M; Siami, Flora S; Sidhu, Mandeep S; Bittner, Vera; Frye, Robert; Fuster, Valentin.
Afiliação
  • Mancini GB; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca.
  • Farkouh ME; Department of Medicine, Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada.
  • Brooks MM; Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania.
  • Chaitman BR; St. Louis University School of Medicine, St. Louis, Missouri.
  • Boden WE; Department of Medicine, Albany Medical College, Albany, New York.
  • Vlachos H; Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania.
  • Hartigan PM; West Haven Veterans Administration Coordinating Center, West Haven, Connecticut.
  • Siami FS; New England Research Institutes, Incorporated, Watertown, Massachusetts.
  • Sidhu MS; Department of Medicine, Albany Medical College, Albany, New York.
  • Bittner V; University of Alabama at Birmingham, Birmingham, Alabama.
  • Frye R; Mayo Clinic, Rochester, Minnesota.
  • Fuster V; Icahn School of Medicine at Mount Sinai, New York, New York.
J Am Coll Cardiol ; 68(10): 985-95, 2016 09 06.
Article em En | MEDLINE | ID: mdl-27585501
BACKGROUND: There are scant outcomes data in patients with type 2 diabetes and stable coronary artery disease (CAD) stratified by detailed angiographic burden of CAD or left ventricular ejection fraction (LVEF). OBJECTIVES: This study determined the effect of optimal medical therapy (OMT), with or without percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), on long-term outcomes with respect to LVEF and number of diseased vessels, including proximal left anterior descending artery involvement. METHODS: A patient-level pooled analysis was undertaken in 3 federally-funded trials. The primary endpoint was the composite of death, myocardial infarction (MI), or stroke, adjusted for trial and randomization strategy. RESULTS: Among 5,034 subjects, 15% had LVEF <50%, 77% had multivessel CAD, and 28% had proximal left anterior descending artery involvement. During a median 4.5-year follow-up, CABG + OMT was superior to PCI + OMT for the primary endpoint (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.59 to 0.85; p = 0.0002), death (HR: 0.76; 95% CI: 0.60 to 0.96; p = 0.024), and MI (HR: 0.50; 95% CI: 0.38 to 0.67; p = 0.0001), but not stroke (HR: 1.54; 95% CI: 0.96 to 2.48; p = 0.074). CABG + OMT was also superior to OMT alone for prevention of the primary endpoint (HR: 0.79; 95% CI: 0.64 to 0.97; p = 0.022) and MI (HR: 0.55; 95% CI: 0.41 to 0.74; p = 0.0001), and was superior to PCI + OMT for the primary endpoint in patients with 3-vessel CAD (HR: 0.72; 95% CI: 0.58 to 0.89; p = 0.002) and normal LVEF (HR: 0.71; 95% CI: 0.58 to 0.87; p = 0.0012). There were no significant differences in OMT versus PCI + OMT. CONCLUSIONS: CABG + OMT reduced the primary endpoint during long-term follow-up in patients with type 2 diabetes and stable CAD, supporting this as the preferred management strategy.
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Texto completo: 1 Coleções: 01-internacional Temas: Geral Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Ponte de Artéria Coronária / Diabetes Mellitus Tipo 2 / Intervenção Coronária Percutânea Tipo de estudo: Clinical_trials / Observational_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Cardiol Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Temas: Geral Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Ponte de Artéria Coronária / Diabetes Mellitus Tipo 2 / Intervenção Coronária Percutânea Tipo de estudo: Clinical_trials / Observational_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Cardiol Ano de publicação: 2016 Tipo de documento: Article