Outcomes of Myocardial Revascularization in Diabetic Patients With Left Main Coronary Artery Disease: A Multicenter Observational Study From Three Gulf Countries

Daoulah, Amin; Elfarnawany, Amr; Garni, Turki Al; Hersi, Ahmad; Alshehri, Mohammed; Almahmeed, Wael; Yousif, Nooraldaem; Abuelatta, Reda; Alasmari, Abdulaziz; Elsheikh-Mohamed, Nezar Essam; Alzahrani, Badr; Ghani, Mohamed Ajaz; Amin, Haitham; Hashmani, Shahrukh; Hiremath, Niranjan; Alshali, Khalid Z.; Elmahrouk, Youssef; Kazim, Hameedullah M.; Refaat, Wael; Selim, Ehab; Jamjoom, Ahmed; Feteih, Maun; El-Sayed, Osama; Al-Faifi, Salem M.; Dahdouh, Ziad; Aithal, Jairam; Ibrahim, Ahmed M.; Elganady, Abdelmaksoud; Qutub, Mohammed A; Alama, Mohamed Nabil; Abohasan, Abdulwali; Hassan, Taher; Balghith, Mohammed; Hussien, Adnan Fathey; Abdulhabeeb, Ibrahim A M; Ahmad, Osama; Ramadan, Mohamed; Alqahtani, Abdulrahman; Abumelha, Bader K.; Qenawi, Wael; Shawky, Ahmed; Ghonim, Ahmed A.; Elmahrouk, Ahmed F.; Alhamid, Sameer; Maghrabi, Mohamed; Haddara, Mamdouh; Aljohar, Alwaleed; Hurley, William T.; Alshahrani, Saif S.; Lotfi, Amir

doi:10.1016/j.carrev.2022.08.002

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…The study is from The Gulf Left-Main registry database. [9][10][11][12][13][14] The study included patients who had CABG for unprotected left-main disease, were discharged on either single or DAPT, and had a follow-up of at least 6 months. Patients with protected left-main disease, hospital mortality, concomitant valve or aortic surgery, previous revascularization for LMCA disease, and patients who had follow-up for less than 6 months were excluded from the analysis.…”

Section: Study Design and Patientsmentioning

confidence: 99%

Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease

Daoulah,

Qenawi,

Alshehri

et al. 2023

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Background: The use of dual antiplatelet therapy (DAPT) after coronary revascularization for left-main disease is still debated. The study aimed to characterize patients who received dual versus single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients. Results: This multicenter retrospective cohort study included 551 patients who were grouped into 2 groups: patients who received SAPT (n = 150) and those who received DAPT (n = 401). There were no differences in age (P = 0.451), gender (P = 0.063), smoking (P = 0.941), diabetes mellitus (P = 0.773), history of myocardial infarction (P = 0.709), chronic kidney disease (P = 0.615), atrial fibrillation (P = 0.306), or cerebrovascular accident (P = 0.550) between patients who received SAPT versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [87 (58%) vs. 273 (68.08%); P = 0.027], after off-pump CABG [12 (8%) vs. 73 (18.2%); P = 0.003] and in patients with radial artery grafts [1 (0.67%) vs. 32 (7.98%); P < 0.001]. While SAPTs were more commonly used in patients with low ejection fraction [55 (36.67%) vs. 61 (15.21%); P < 0.001] and in patients with postoperative acute kidney injury [27 (18%) vs. 37 (9.23%); P = 0.004]. The attributed treatment effect of DAPT for follow-up major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, −2.08 (95% confidence interval (CI), −20.8–16.7); P = 0.828]. The attributed treatment effect of DAPT on follow-up all-cause mortality was not significantly different from that of SAPT [β, 4.12 (CI, −11.1–19.32); P = 0.595]. There was no difference in bleeding between groups (P = 0.666). Conclusions: DAPTs were more commonly used in patients with acute coronary syndrome, after off-pump CABG, and with radial artery grafts. SAPTs were more commonly used in patients with low ejection fraction and acute kidney injury. Patients on DAPT after CABG for left-main disease had comparable major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events.

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Section: Study Design and Patientsmentioning

confidence: 99%

Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease

Daoulah,

Qenawi,

Alshehri

et al. 2023

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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“…Due to advancements in drug-eluting stent (DES) technology, antithrombotic drugs, procedural techniques, and interventional cardiologists' experience, PCI has been increasingly more widely employed over the last 10 years for the treatment of ULMCAD. Given that PCI in ULMCAD has shown encouraging results in both large registries and randomized clinical trials (RCTs) guidelines now recommend treatment as a viable option to CABG in certain patients (70 percent in Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial, produced results that were inconsistent over an extended period of time, raising concerns about the best revascularization method for ULMC [4][5][6]. The medical outcomes of PCI and CABG revascularization for ULMCAD are similar, even if their effectiveness in "real world" conditions is still debatable.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Left Main Coronary Artery Revascularization after Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting Surgery

Amin¹,

Khan²,

Shah³

et al. 2022

PJMHS

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Background: Our study's major goal is to examine how several existing ULMCAD Currently, percutaneous coronary intervention (PCI) and coronary artery bypass grafting are the most common non-invasive methods of treating (unprotected left predominant) CAD in the United States (CABG). Place of study and duration: Conducted at the department of Cardiology, Hayatabad Medical Complex, Peshawar for the Duration from July 1 -2016 to Jun 30 -2017. Methods and Results: The effects of PCI and CABG have been analyzed in 558 patients with ULMCAD in a row (suggest age 71.9 years, eighty-one percent male). The most important end results were a total prevalence of mortality, nonfatal MI, and stroke. Diabetes prevalence increased to 29 percent, whereas acute coronary syndrome increased to 56 percent and 11 became the standard Euro SCORE. An extremely complicated form of coronary disease affected 50% of the patients (SYNTAX score >32). Up to four years after PCI and CABG, the primary composite outcomes were equivalent (15, 53, 1 percent vs. 17,126.6 percent; p=0.585). Additionally, the impacts on the top findings were equivalent for the 2 cohorts with similar propensity ratings. Revascularization was required in 5.5 percent of PCI patients and 1.5 percent of CABG patients, respectively, due to ischemia (p=0.010). Conclusions: According to our local network of ULMCAD patients, the long-term scientific outcomes of the present PCI or CABG revascularization procedures were equivalent. No matter the intricacy of the coronary artery.

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Revascularization of Left Main Coronary Artery in Patients With Diabetes: Is the Pendulum Swinging to PCI?

Paul

Naidu

2023

Cardiovascular Revascularization Medicine

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Outcomes of Myocardial Revascularization in Diabetic Patients With Left Main Coronary Artery Disease: A Multicenter Observational Study From Three Gulf Countries

Cited by 6 publications

References 33 publications

Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease

Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease

Outcomes of Left Main Coronary Artery Revascularization after Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting Surgery

Revascularization of Left Main Coronary Artery in Patients With Diabetes: Is the Pendulum Swinging to PCI?

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