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Outcomes of Coronary Revascularization (Percutaneous or Bypass) in Patients With Diabetes Mellitus and Multivessel Coronary Disease

Hee, Leia ; Mussap, Christian J ; Yang, Lihua ; Dignan, Rebecca ; Kadappu, Krishna K ; Juergens, Craig P ; Thomas, Liza ; French, John K

The American Journal of Cardiology, 01 September 2012, Vol.110(5), pp.643-648 [Peer Reviewed Journal]

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  • Title:
    Outcomes of Coronary Revascularization (Percutaneous or Bypass) in Patients With Diabetes Mellitus and Multivessel Coronary Disease
  • Author: Hee, Leia ; Mussap, Christian J ; Yang, Lihua ; Dignan, Rebecca ; Kadappu, Krishna K ; Juergens, Craig P ; Thomas, Liza ; French, John K
  • Description: Clinical outcomes in patients with diabetes mellitus and multivessel disease (MVD) undergoing coronary revascularization have not been extensively evaluated, we sought to examine outcomes in a diabetic cohort of 195 consecutive patients with MVD characterized by SYNTAX scores (SSs) undergoing nonrandomized revascularization, 102 (52%) by percutaneous intervention (PCI) and 93 (48%) by coronary artery bypass grafting (CABG) at Liverpool Hospital (Sydney, Australia) from June 2006 to March 2010. Clinical outcomes were assessed at a median term of 14 months. The overall median SS was 44, with significantly higher SSs in CABG- than PCI-treated patients (48 vs 39, p <0.0001). There was a similar incidence of all-cause death, nonfatal myocardial infarction and stroke in PCI- and CABG-treated patients (6.1% vs 8.3%, p = 0.383; 12% vs 4.9%, p = 0.152; 3.1% vs 3.5%, p = 0.680 respectively). However, the rates of target vessel revascularization and major adverse coronary and cerebral event were significantly higher in PCI-treated patients than in those undergoing CABG (20% vs 1.2%, p <0.0001; 29% vs 15%, p = 0.034). Despite a much higher SS, patients who underwent PCI achieved comparable outcomes at 1 year to those with diabetes mellitus and a SS ≥33 as reported in the SYNTAX trial. In conclusion, in this single-center nonrandomized observational study, coronary revascularization by PCI is associated with increased major adverse coronary and cerebral events at 1-year follow-up, predominantly driven by a high rate of target vessel revascularization. Thus, CABG should remain the revascularization procedure of choice for diabetic patients with MVD and high SSs.
  • Is Part Of: The American Journal of Cardiology, 01 September 2012, Vol.110(5), pp.643-648
  • Identifier: ISSN: 0002-9149 ; E-ISSN: 1879-1913 ; DOI: 10.1016/j.amjcard.2012.04.043
  • Subjects: Medicine
  • Language: English
  • Source: ScienceDirect Journals (Elsevier)

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