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

Zheng

Front. Cardiovasc. Med.

et al. 2022

ObjectiveGensini score is an effective tool used to evaluate the severity of coronary artery disease (CAD). Whether the Gensini score has predictive value for the clinical outcomes of patients with CAD after percutaneous coronary intervention (PCI) has not been investigated.MethodsAll patients were from the Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI (CORFCHD-PCI), a retrospective cohort study involving 5,672 patients with CAD who underwent PCI, such as 2,110 patients with diabetes and 3,562 patients without diabetes, from January 2008 to December 2017. Patients were divided into three groups according to the tertile of Gensini score: first tertile (Gensini score <11 points), second tertile (Gensini score 11–38 points), and third tertile (Gensini score >38 points). The median follow-up time was 31.0 (interquartile range, IQR: 30.0) months. Compared the differences in clinical outcomes between the groups. Multivariate Cox regression analyses were performed to assess the predictive value of the Gensini score for outcomes over up to 10 years of follow-up.ResultsIn the population without diabetes, there were significant differences between the three groups in the incidences of all-cause mortality (ACM, p = 0.048), cardiac mortality (CM, p = 0.024), major adverse cardiovascular (CV) events (MACEs, p = 0.006), and major adverse cardiovascular and cerebrovascular events (MACCEs, p = 0.009). In the population with diabetes, there were significant differences between the three groups in the incidences of ACM, CM, MACEs, and MACCEs (all p < 0.001). After multivariate Cox regression analyses, in the population without diabetes, the respective risks of ACM, CM, MACEs, and MACCEs were increased 89.9% [hazard ratio (HR) = 1.899, 95% CI: 1.285–2.807, p = 0.001], 115.1% (HR = 2.151, 95% CI: 1.378–3.356, p = 0.001), 48.1% (HR = 1.481, 95% CI: 1.152–1.904, p = 0.002), and 49.8% (HR = 1.498, 95% CI: 1.176–1.907, p = 0.001) in the third tertile compared with those in the first tertile. In the population with diabetes, the respective risks of ACM, CM, MACEs, and MACCEs were increased 248.5% (HR = 3.485, 95% CI: 1.973–6.154, p < 0.001), 260.4% (HR = 3.604, 95% CI: 1.866–6.963, p < 0.001), 130.2% (HR = 2.302, 95% CI: 1.649–3.215, p < 0.001), and 119.8% (HR = 2.198, 95% CI: 1.600–3.018, p < 0.001) in the third tertile compared with those in the first tertile.ConclusionThe present study indicated that the Gensini score is an independent predictor of long-term adverse outcomes in patients with CAD who underwent PCI, and it has more predictive value in the population with diabetes.

Section: Discussionmentioning

confidence: 99%

Predictive Value of Gensini Score in the Long-Term Outcomes of Patients With Coronary Artery Disease Who Underwent PCI

Zheng

Front. Cardiovasc. Med.

et al. 2022

Journal of Cardiac Surgery

“…Even with multivariable analyses and statistical adjustment, these studies may be subject to residual confounding, as patients referred for CABG in a clinical (or nonrandomized) setting are fundamentally different than those referred for PCI. Meta‐analyses including observational studies are subject to similar biases 10,11 …”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of percutaneous versus surgical revascularization in patients with diabetes and left main coronary artery disease: A meta‐analysis of randomized controlled trials

Carvalho

Veiga

Machado

et al. 2022

Background The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established. Objectives To perform a meta‐analysis evaluating the long‐term outcomes after PCI with drug‐eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD. Methods MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long‐term effects of these interventions, we restricted this analysis to studies with a minimum follow‐up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random‐effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all‐cause mortality (RR: 1.21; 95% CI: 0.86–1.71; p = .27; I2 = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76–2.18; p = .34; I2 = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61–1.45; p = .79; I2 = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18–0.94; p = .04; I2 = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44–2.75; p < .001; I2 = 0%). The risk of the composite outcome of all‐cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09–1.56; p = .004; I2 = 0%). Conclusion In this meta‐analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG.

“…Although the mortality of CAD has been well-controlled with the development of interventional strategies, the prognosis of patients with CAD and T2DM is still very poor [26]. The CAD and T2DM patients are prone to a more rapid progression of atherosclerosis, significantly increasing the need for myocardial revascularization [27]. Besides, patients with T2DM also have a worse prognosis following a coronary revascularization procedure [28].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Repeat Revascularization within 7 Years of First Percutaneous Coronary Intervention in a Diabetic Patient

Marta¹,

Andrei²,

Ana³

et al. 2022

Act Scie Medic

Background: Despite increased attention to more intensive medical therapy for patients with established coronary artery disease (CAD), the presence of type 2 diabetes mellitus (T2DM) is associated with extended vascular atherosclerotic lesions in sites unrelated to the revascularized segment leading to an increased tendency to postrevascularization target and nontarget vessel ischemic events. Material and Methods:We report a case of a 66-year-old man with insulin dependent type 2 diabetes patient who has been admitted to the emergency department for an ischemic event: atypical chest pain after physical exertion.The Aim of the Study: to evaluate the risk factors associated with repeat revascularization within 7 years of first percutaneous coronary intervention (PCI) in a diabetic patient.Results: On initial evaluation the patient presented with the symptoms of atypical chest pain, confined in the epigastrium, dyspnea.The physical findings of the patient: atrial fibrillation, hypotension, type 2 diabetes with macro-and microangiopathy, chronic kidney disease (CKD), hyperlipidemia, previous revascularization by PCI were revealed. The recent coronary angiography showed multivessel atherosclerotic lesions in sites unrelated to the previously revascularized segments. Conclusion:The obtained data suggest that the factors associated with repeat revascularization within 7 years of first percutaneous coronary intervention of the presented case are uncontrolled type 2 diabetes mellutis, CKD, dyslipidemia and the progression of atherosclerosis with the involvement of multivessel legions.