Five-Year Outcomes of Percutaneous Versus Surgical Coronary Revascularization in Patients With Diabetes Mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

doi:10.1016/j.amjcard.2015.01.544

Cited by 34 publications

(39 citation statements)

References 20 publications

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“…We observed greater utilization of PCI versus CABG in this patient population throughout the study period. Furthermore, consistent with previous cohort studies, 15,22,25 we observed that the choice of optimal revascularization strategy in this patient population is particularly influenced by the severity of underlying CAD. Among high-risk patients (3-vessel CAD and pLAD involvement), CABG has been the revascularization strategy of choice throughout the study period.…”

Section: Discussionsupporting

confidence: 77%

“…This is also consistent with findings reported from previous cohort studies. 15,22,25 Several other factors may also influence the choice of revascularization strategy in favor of PCI over CABG in this patient population. First, revascularization decisions in usual clinical practice may be different in patients with NSTEMI than those with stable CAD.…”

Section: Discussionmentioning

confidence: 99%

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Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non–ST Elevation Myocardial Infarction

Pandey

McGuire

Lemos

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background-Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction. Methods and Results-Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4%) were treated with CABG, 13 760 (46.2%) were treated with PCI, and 5157 (17.3%) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45% to 48.9%; P trend =0.0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; p trend =0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22%-100%; 0%-78%, respectively; P value <0.0001 for both). Patient-level, but not hospital-level, characteristics were statistically associated with the use of PCI versus CABG, including anatomic severity of the disease, early treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure. Conclusions-Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years. (Circ Cardiovasc Qual Outcomes. 2016;9:197-205.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non–ST Elevation Myocardial Infarction

Pandey

McGuire

Lemos

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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“…According to local and Medicare data, the post-procedural incidence of AKI was higher following CABG than PCI [16,17]. However, comparative results regarding short-term mortality are inconsistent, with some studies showing higher short-term mortality following CABG in patients with or without chronic kidney disease (CKD) [18,19,20] while others report no difference in 30-day survival between CABG and PCI [16,21]. We are aware of no contemporary national study comparing the incidence of AKI after CABG vs. PCI in the general population.…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study

Shen

Aguilar

Montero³

et al. 2017

Am J Nephrol

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Background: Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. Methods: We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups. Results: The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges. Conclusions: Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.

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“…Other factors that emerged as having a significant effect on the likelihood of readmission or death were diabetes, anemia, and previous coronary disease, whose effects have also been documented. Of particular interest was the greater protection associated with bypass versus percutaneous surgery, which agrees with the results of studies comparing the two procedures [24]. Regarding obesity, its paradoxical protective effect against death during the hospital stay is known [25] and can be attributed to residual confounding or to the high incidence of ACS in patients with an excess of adipose tissue, including some with a better initial prognosis.…”

Section: Discussionmentioning

confidence: 58%

Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome

et al. 2016

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ObjectivesTo determine whether the risk of cardiovascular mortality associated with cardiorenal syndrome subtype 1 (CRS1) in patients who were hospitalized for acute coronary syndrome (ACS) was greater than the expected risk based on the sum of its components, to estimate the predictive value of CRS1, and to determine whether the severity of CRS1 worsens the prognosis.MethodsFollow-up study of 1912 incident cases of ACS for 1 year after discharge. Cox regression models were estimated with time to event (in-hospital death, and readmission or death during the first year after discharge) as the dependent variable.ResultsThe incidence of CRS1 was 9.2/1000 person-days of hospitalization (95% CI = 8.1–10.5), but these patients accounted for 56.6% (95% CI = 47.4–65.) of all mortality. The positive predictive value of CRS1 was 29.6% (95% CI = 23.9–36.0) for in-hospital death, and 51.4% (95% CI = 44.8–58.0) for readmission or death after discharge. The risk of in-hospital death from CRS1 (RR = 18.3; 95% CI = 6.3–53.2) was greater than the sum of risks associated with either acute heart failure (RR = 7.6; 95% CI = 1.8–31.8) or acute kidney injury (RR = 2.8; 95% CI = 0.9–8.8). The risk of events associated with CRS1 also increased with syndrome severity, reaching a RR of 10.6 (95% CI = 6.2–18.1) for in-hospital death at the highest severity level.ConclusionsThe effect of CRS1 on in-hospital mortality is greater than the sum of the effects associated with each of its components, and it increases with the severity of the syndrome. CRS1 accounted for more than half of all mortality, and its positive predictive value approached 30% in-hospital and 50% after discharge.

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Five-Year Outcomes of Percutaneous Versus Surgical Coronary Revascularization in Patients With Diabetes Mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Cited by 34 publications

References 20 publications

Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non–ST Elevation Myocardial Infarction

Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non–ST Elevation Myocardial Infarction

Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study

Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome

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