Long‐Term (10‐Year) Outcomes of Stenting or Bypass Surgery for Left Main Coronary Artery Disease in Patients With and Without Diabetes Mellitus

Lee, Kyusup; Ahn, Jung‐Min; Yoon, Yong‐Hoon; Kang, Do‐Yoon; Park, Seo Young; Ko, Euihong; Park, Hanbit; Cho, Sang‐Cheol; Park, Sangwoo; Kim, Tae Oh; Lee, Pil Hyung; Lee, Seung‐Whan; Park, Seong‐Wook; Park, Duk‐Woo; Park, Seung‐Jung

doi:10.1161/jaha.119.015372

Cited by 24 publications

(23 citation statements)

References 33 publications

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“…On the basis of the inclusion and exclusion criteria, further eliminations were carried out: 293 articles were eliminated because they were based on a follow-up time period less than 10 years; 62 publications were meta-analyses, systematic reviews, or literature reviews; 21 articles were case studies; and 130 articles were duplicated studies. Finally, only eight studies [16][17][18][19][20][21][22][23] including three randomized trials and five observational cohorts were selected for this analysis as shown in Fig. 1.…”

Section: Search Outcomesmentioning

confidence: 99%

Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis

Wang

Wei

et al. 2021

Diabetes Ther

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Introduction In this meta-analysis, we aimed to systematically compare the 10-year outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with type 2 diabetes mellitus (T2DM) suffering from left main coronary artery disease (LMCD). Methods Medical Literature Analysis and Retrieval System Online (MEDLINE), http://www.ClinicalTrials.gov , Excerpta Medica dataBASE (EMBASE), Cochrane Central, Web of Science, and Google scholar were searched for publications comparing 10-year outcomes of PCI versus CABG in patients with T2DM suffering from LMCD. Cardiovascular outcomes were considered as the clinical endpoints. Statistical analysis was carried out using RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after analysis. Results Eight studies (three randomized trials and five observational studies) with a total number of 3835 participants with T2DM were included in this analysis; 2340 participants were assigned to the PCI group and 1495 participants were assigned to the CABG group. Results of this analysis showed that mortality (RR 0.85, 95% CI 0.73–1.00; P = 0.05), myocardial infarction (RR 0.53, 95% CI 0.35–0.80; P = 0.002), repeated revascularization (RR 0.34, 95% CI 0.26–0.46; P = 0.00001), and target vessel revascularization (RR 0.26, 95% CI 0.18–0.38; P = 0.00001) were significantly higher with PCI when compared to CABG in these patients with diabetes and LMCD. Major adverse cardiac and cerebrovascular events were also significantly higher with PCI at 10 years (RR 0.67, 95% CI 0.49–0.92; P = 0.01). However, CABG was associated with a significantly higher risk of stroke (RR 2.16, 95% CI 1.39–3.37; P = 0.0007). Conclusions During a long-term follow-up time period of 10 years, PCI was associated with worse clinical outcomes compared to CABG in these patients with T2DM suffering from LMCD. However, a significantly higher risk of stroke was observed with CABG. This piece of information might be vital in order to carefully choose and prevent complications following revascularization in such patients.

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Section: Search Outcomesmentioning

confidence: 99%

Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis

Wang

Wei

et al. 2021

Diabetes Ther

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“…Recent long‐term report from the MAIN‐COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry reported that the clinical impact of DM favoring CABG over PCI has diminished over time from the bare‐metal stent to the DES. 19 Despite this, currently, no specific recommendations exist concerning the optimal revascularization strategy in patients with DM with LMCA disease. 10 …”

Section: Discussionmentioning

confidence: 99%

Ten‐year Outcomes After Drug‐Eluting Stents or Bypass Surgery for Left Main Coronary Disease in Patients With and Without Diabetes Mellitus: The PRECOMBAT Extended Follow‐Up Study

Jeong

Ahn

Hyun

et al. 2021

JAHA

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Background Several trials reported differential outcomes after percutaneous coronary intervention with drug‐eluting stents (DES) and coronary‐artery bypass grafting (CABG) for multivessel coronary disease according to the presence of diabetes mellitus (DM). However, it is not well recognized how DM status affects very‐long‐term (10‐year) outcomes after DES and CABG for left main coronary artery disease. Methods and Results In the PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty using Sirolimus‐Eluting Stent in Patients with Left Main Coronary Artery Disease) trial, patients with LMCA were randomly assigned to undergo PCI with sirolimus‐eluting stents (n=300) or CABG (n=300). The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (MACCE; a composite of death from any cause, myocardial infarction, stroke, or ischemia‐driven target‐vessel revascularization). Outcomes were examined in patients with (n=192) and without (n=408) medically treated diabetes. The follow‐up was extended to at least 10 years for all patients (median, 11.3 years). The 10‐year rates of MACCE were not significantly different between DES and CABG in patients with DM (36.3% versus 26.7%, respectively; hazard ratio [HR], 1.35; 95% CI, 0.83–2.19; P =0.23) and without DM (25.3% versus 22.9%, respectively; HR, 1.15; 95% CI, 0.79–1.67; P =0.48) ( P ‐for‐interaction=0.48). There were no significant between‐group differences in composite of death, MI, or stroke, and all‐cause mortality, regardless of DM status. TVR rates were consistently higher after DES than CABG. Conclusions In this 10‐year extended follow‐up of PRECOMBAT, we found no significant difference between DES and CABG with respect to the incidences of MACCE, serious composite outcome, and all‐cause mortality in patients with and without DM with LMCA disease. However, owing to the limited number of patients and no adjustment for multiple testing, overall findings should be considered hypothesis‐generating, highlighting the need for further research. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03871127 and NCT00422968.

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“…In LMSD, comparable adverse outcomes and mortality was observed in CABG and PTCA. 7,39 It could be argued that the above studies were underpowered as they did not utilise newer secondgeneration drug-eluting stent, Everolimus. NOBEL trial 40 and EXCEL trial 41 were two largest randomised trials that included Everolimus but they were not powered to study diabetic patients exclusively.…”

Section: Discussionmentioning

confidence: 99%

Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

Musa¹,

Min²,

Rahim³

et al. 2020

JDMDC

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onset diabetes of the young; LADA, latent autoimmune diabetes of adulthood; MI, myocardial infarction; LMSD, left main stem disease; MVD, multivessel disease; DES, drug eluting stent; RCS, randomised controlled trials; OS, observational studies; BARI, bypass angioplasty revascularization investigation; MACCE, major adverse cardiac and cerebrovascular events; EES, everolimus-eluting stent; ACR, hybrid coronary revascularization diabetes. 1 Compared to non-diabetic patients, the rate of mortality and adverse events in patients with diabetes is significantly higher. 2-4 Early revascularization could enhance their prognosis. 5 Nonetheless, the long-term merits of utilising either CABG or PTCA remains debatable. Aim Our study aims to investigate whether diabetic patients fare better in the long term with PTCA compared to CABG. Methods We conducted a literature search dating from January 2010 to June 2020 using PubMed, MEDLINE, Cochrane and Embase database to identify relevant articles. Medical Subject Heading (MeSH) terms such as "diabetes mellitus" "Percutaneous Transluminal Coronary Angioplasty" and "Coronary Artery Bypass Surgery" were used to identify journal articles. To allow additional relevant references selected, cross checking of references was also performed. We included studies that were (1) published from January 2010 to June 2020 with a (2) minimum duration of patient follow-up of five years regarding (3) revascularization of patients with Type 2 diabetes mellitus.

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Long‐Term (10‐Year) Outcomes of Stenting or Bypass Surgery for Left Main Coronary Artery Disease in Patients With and Without Diabetes Mellitus

Cited by 24 publications

References 33 publications

Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis

Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis

Ten‐year Outcomes After Drug‐Eluting Stents or Bypass Surgery for Left Main Coronary Disease in Patients With and Without Diabetes Mellitus: The PRECOMBAT Extended Follow‐Up Study

Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

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