Strategies for Multivessel Revascularization in Patients with Diabetes

Farkouh, Michael E.; Domanski, Michael J.; Sleeper, Lynn A.; Siami, Flora S.; Dangas, George; Mack, Michael J.; Yang, May; Cohen, David J.; Rosenberg, Yves; Solomon, Scott D.; Desai, Akshay S.; Gersh, Bernard J.; Magnuson, Elizabeth A.; Lansky, Alexandra J.; Boineau, Robin; Weinberger, Jesse; Ramanathan, Krishnan; Sousa, J. Eduardo; Rankin, Jamie; Bhargava, Balram; Buse, John B.; Hueb, Whady; Smith, Craig R.; Muratov, Victoria; Bansilal, Sameer; King, Spencer B.; Bertrand, Michel E.; Fuster, Valentín

doi:10.1056/nejmoa1211585

Cited by 1,654 publications

(1,066 citation statements)

References 21 publications

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“…Although, contemporary population data demonstrates evidence of reduction in cardiovascular complications with risk factor control in patients with diabetes 5, 6, it is not known whether this translates to improvements following coronary revascularization as recent randomized control trials continue to show worst outcomes in diabetic patients with complex coronary artery disease when treated with PCI compared with coronary artery bypass graft (CABG) 7, 8, 9.…”

Section: Introductionmentioning

confidence: 99%

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Noman

Balasubramaniam

Alhous

et al. 2016

Cathet Cardio Intervent

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ObjectivesTo assess the mortality in patients with diabetes mellitus (DM) following percutaneous coronary intervention (PCI) according to their insulin requirement and PCI setting (elective, urgent, and emergency).BackgroundDM is a major risk factor to develop coronary artery disease (CAD). It is unclear if meticulous glycemic control and aggressive risk factor management in patients with DM has improved outcomes following PCI.MethodsRetrospective analysis of prospectively collected data on 9,224 patients treated with PCI at a regional tertiary center between 2008 and 2011.ResultsAbout 7,652 patients were nondiabetics (non‐DM), 1,116 had non‐insulin treated diabetes mellitus (NITDM) and 456 had ITDM. Multi‐vessel coronary artery disease, renal impairment and non‐coronary vascular disease were more prevalent in DM patients. Overall 30‐day mortality rate was 2.4%. In a logistic regression model, the adjusted odds ratios (95% confidence intervals [CI]) for 30‐day mortality were 1.28 (0.81–2.03, P = 0.34) in NITDM and 2.82 (1.61–4.94, P < 0.001) in ITDM compared with non‐DM. During a median follow‐up period of 641 days, longer‐term post‐30 day mortality rate was 5.3%. In the Cox's proportional hazard model, the hazard ratios (95% CI) for longer‐term mortality were 1.15 (0.88–1.49, P = 0.31) in NITDM and 1.88 (1.38–2.55, P < 0.001) in ITDM compared with non‐DM group. Similar result was observed in all three different PCI settings.ConclusionIn the modern era of aggressive cardiovascular risk factor control in diabetes, this study reveals higher mortality only in insulin‐treated diabetic patients following PCI for stable coronary artery disease and acute coronary syndrome. Importantly, diabetic patients with good risk factor control and managed on diet or oral hypoglycemics have similar outcomes to the non‐diabetic population. © 2016 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Noman

Balasubramaniam

Alhous

et al. 2016

Cathet Cardio Intervent

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“…Hasil ini serupa dengan penelitian-penelitian yang lainnya. 5,7,9,10 Hal tersebut terkait usia yang merupakan salah satu faktor risiko terjadinya PJK.Semakin bertambah usia, maka semakin besar risiko mengalami PJK. Namun, pada penelitian ini tidak dilakukan analisis pengaruh usia terhadap kesintasan disebabkan sebaran data yang tidak merata.…”

Section: Karakteristikunclassified

Kesintasan Lima Tahun Pasien Penyakit Jantung Koroner Tiga Pembuluh Darah dengan Diabetes Melitus yang Menjalani Bedah Pintas Koroner, Intervensi Koroner Perkutan atau Medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo

Setiawan¹,

Panggabean²,

Yamin³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Hasil revaskularisasi pada pasien diabetes melitus (DM) dengan penyakit jantung koroner 3 pembuluh darah (PJK 3PD) dengan bedah pintas koroner (BPK) lebih baik dibandingkan intervensi koroner perkutan (IKP) atau medikamentosa. BPK tidak selalu menjadi prosedur yang dikerjakan meskipun sudah direkomendasikan sesuai Skor Syntax. Selain itu, tidak semua pasien bersedia menjalani BPK atau IKP. Perlu diketahui apakah pilihan revaskularisasi tersebut mempengaruhi kesintasan 5 tahun.Metode. Penelitian ini merupakan studi kohort retrospektif dengan pendekatan analisis kesintasan untuk meneliti kesintasan 5 tahun pasien PJK 3PD DM yang menjalani tindakan BPK, IKP atau medikamentosa. Penelitian dilakukan dengan menggunakan data sekunder 126 pasien PJK 3PD DM yang menjalani BPK, IKP, maupun medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada tahun 2006-2007 dan diikuti sampai dengan tahun 2011-2012 dengan dilihat adakah kejadian meninggal.Hasil. Kesintasan terbaik diketahui yaitu pada kelompok BPK (93,5%). Proporsi kematian terbesar terdapat pada kelompok medikamentosa (36,1%). Selain itu, hasil analisis menunjukkan bahwa kelompok IKP memiliki kesintasan yang lebih baik dibanding medikamentosa (69,5% vs 63,9%). Meskipun tidak bermakna secara statistik, namun pada kelompok IKP proporsi keluhan yang ditemukan setelah tindakan lebih sedikit dibanding kelompok medikamentosa (52% vs 38%). Skor Syntax yang berperan menilai kompleksitas stenosis diketahui turut menentukan kesintasan (p= 0,039).Simpulan. Kesintasan 5 tahun pasien PJK 3PD dengan DM yang paling baik didapatkan pada kelompok yang menjalani BPK. Kesintasan 5 tahun pasien PJK 3PD dengan DM yang menjalani IKP lebih baik dibandingkan medikamentosa, namun secara statistik tidak bermakna. Faktor yang berpengaruh pada kesintasan 5 tahun pasien PJK 3PD adalah kompleksitas stenosis yang dilihat dengan menggunakan skor Syntax. Kata kunci: DM, kesintasan 5 tahun, PJK 3PD

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“…While advances in PTCA like DES reduce some of these side effects so much so that in many patients with 1-or 2-vessel disease there may be hardly any difference between the two approaches, but for multivessel CAD, the difference may become crucial. In this subgroup, CABG is not only associated with fewer recurrent events or need for re-intervention but also better survival and thus studies after studies consistently demonstrated the superiority of CABG over PTCA, use of DES notwithstanding [4,5]. Similarly, in other situations of profoundly virulent atherosclerosis, CABG may be the best option.…”

Section: Effect Of Diabetes Mellitusmentioning

confidence: 99%

The shifting sands of coronary practice: from cardiologist’s amusement to a surgeon’s avocation

Mishra

2017

Indian J Thorac Cardiovasc Surg

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The field of coronary artery disease therapy has evolved over a period of time from medical therapy to coronary bypass surgery to interventional cardiology. However, none of the therapies have become obsolete and there is still place for optimal medical therapy, cardiac surgery as percutaneous interventions. The need of the hour is to develop an integrated multi-disciplinary approach popularly known as heart team approach at least for complex situations whether patient or lesion related.

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Strategies for Multivessel Revascularization in Patients with Diabetes

Cited by 1,654 publications

References 21 publications

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

Kesintasan Lima Tahun Pasien Penyakit Jantung Koroner Tiga Pembuluh Darah dengan Diabetes Melitus yang Menjalani Bedah Pintas Koroner, Intervensi Koroner Perkutan atau Medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo

The shifting sands of coronary practice: from cardiologist’s amusement to a surgeon’s avocation

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