Surgical Versus Percutaneous Coronary Revascularization in Patients With Diabetes and Acute Coronary Syndromes.
J Am Coll Cardiol
; 70(24): 2995-3006, 2017 Dec 19.
Article
en En
| MEDLINE
| ID: mdl-29241487
ABSTRACT
BACKGROUND:
Randomized trial data support the superiority of coronary artery bypass grafting (CABG) surgery over percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary artery disease (MV-CAD). However, whether this benefit is seen in a real-world population among subjects with stable ischemic heart disease (SIHD) and acute coronary syndromes (ACS) is unknown.OBJECTIVES:
The main objective of this study was to assess the generalizability of the FREEDOM (Future REvascularization Evaluation in Patients with Diabetes Mellitus Optimal Management of Multi-vessel Disease) trial in real-world practice among patients with diabetes mellitus and MV-CAD in residents of British Columbia, Canada. Additionally, the study evaluated the impact of mode of revascularization (CABG vs. PCI with drug-eluting stents) in diabetic patients with ACS and MV-CAD.METHODS:
In a large population-based database from British Columbia, this study evaluated major cardiovascular outcomes in all diabetic patients who underwent coronary revascularization between 2007 and 2014 (n = 4,661, 2,947 patients with ACS). The primary endpoint (major adverse cardiac or cerebrovascular events [MACCE]) was a composite of all-cause death, nonfatal myocardial infarction, and nonfatal stroke. The risk of MACCE with CABG or PCI was compared using multivariable adjustment and a propensity score model.RESULTS:
At 30-days post-revascularization, for ACS patients the odds ratio for MACCE favored CABG 0.49 (95% confidence interval [CI] 0.34 to 0.71), whereas among SIHD patients MACCE was not affected by revascularization strategy (odds ratio 1.46; 95% CI 0.71 to 3.01; pinteraction <0.01). With a median follow-up of 3.3 years, the late (31-day to 5-year) benefit of CABG over PCI no longer varied by acuity of presentation, with a hazard ratio for MACCE in ACS patients of 0.67 (95% CI 0.55 to 0.81) and the hazard ratio for SIHD patients of 0.55 (95% CI 0.40 to 0.74; pinteraction = 0.28).CONCLUSIONS:
In diabetic patients with MV-CAD, CABG was associated with a lower rate of long-term MACCE relative to PCI for both ACS and SIHD. A well-powered randomized trial of CABG versus PCI in the ACS population is warranted because these patients have been largely excluded from prior trials.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Puente de Arteria Coronaria
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Diabetes Mellitus Tipo 2
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Síndrome Coronario Agudo
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Intervención Coronaria Percutánea
Tipo de estudio:
Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Am Coll Cardiol
Año:
2017
Tipo del documento:
Article