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PCI versus CABG for multivessel coronary disease in diabetics.
Catheter Cardiovasc Interv. 2009 Jan 01; 73(1):50-8.CC

Abstract

OBJECTIVES

To explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in diabetic patients with multivessel disease (MVD) compared with coronary artery bypass graft (CABG), when it is based on clinical judgment.

BACKGROUND

Diabetes mellitus (DM) is a major risk factor for poor outcome after PCI. However, PCI may result in better outcome if the choice of revascularization (PCI versus CABG) is based on the physician decision, rather than randomization. Limited experiences have compared revascularization by DES-PCI versus CABG in DM patients with MVD.

METHODS

From August 2004 to August 2005, 220 consecutive DM patients with MVD underwent DES-PCI (93) or CABG (127) at our Institution. The type of revascularization was dependent on patient and/or physician choice. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, repeat coronary revascularization, and stroke.

RESULTS

Compared with PCI patients, CABG patients had higher prevalence of 3-vessel disease (P < 0.001), significant LAD involvement (P < 0.001), presence of total occlusions (P = 0.04), collateral circulation (P < 0.001). At 2-year follow-up, MACCE were not different between CABG group and DES-PCI group (OR 1.2; P = 0.6) and, only when the clinical judgment on the revascularization choice was excluded at propensity analysis, DES-PCI increased the risk of 24-month MACCE in total population (OR 1.8; P = 0.04).

CONCLUSIONS

For patients with DM and MVD, a clinical judgment-based revascularization by DES-PCI is not associated with worse 2-year outcome compared with CABG.

Authors+Show Affiliations

Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy. giuseppe.tarantini.1@unipd.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19089938

Citation

Tarantini, Giuseppe, et al. "PCI Versus CABG for Multivessel Coronary Disease in Diabetics." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 73, no. 1, 2009, pp. 50-8.
Tarantini G, Ramondo A, Napodano M, et al. PCI versus CABG for multivessel coronary disease in diabetics. Catheter Cardiovasc Interv. 2009;73(1):50-8.
Tarantini, G., Ramondo, A., Napodano, M., Favaretto, E., Gardin, A., Bilato, C., Nesseris, G., Tarzia, V., Cademartiri, F., Gerosa, G., & Iliceto, S. (2009). PCI versus CABG for multivessel coronary disease in diabetics. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 73(1), 50-8. https://doi.org/10.1002/ccd.21757
Tarantini G, et al. PCI Versus CABG for Multivessel Coronary Disease in Diabetics. Catheter Cardiovasc Interv. 2009 Jan 1;73(1):50-8. PubMed PMID: 19089938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - PCI versus CABG for multivessel coronary disease in diabetics. AU - Tarantini,Giuseppe, AU - Ramondo,Angelo, AU - Napodano,Massimo, AU - Favaretto,Enrico, AU - Gardin,Arianna, AU - Bilato,Claudio, AU - Nesseris,Georghios, AU - Tarzia,Vincenzo, AU - Cademartiri,Filippo, AU - Gerosa,Gino, AU - Iliceto,Sabino, PY - 2008/12/18/entrez PY - 2008/12/18/pubmed PY - 2009/2/27/medline SP - 50 EP - 8 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 73 IS - 1 N2 - OBJECTIVES: To explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in diabetic patients with multivessel disease (MVD) compared with coronary artery bypass graft (CABG), when it is based on clinical judgment. BACKGROUND: Diabetes mellitus (DM) is a major risk factor for poor outcome after PCI. However, PCI may result in better outcome if the choice of revascularization (PCI versus CABG) is based on the physician decision, rather than randomization. Limited experiences have compared revascularization by DES-PCI versus CABG in DM patients with MVD. METHODS: From August 2004 to August 2005, 220 consecutive DM patients with MVD underwent DES-PCI (93) or CABG (127) at our Institution. The type of revascularization was dependent on patient and/or physician choice. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, repeat coronary revascularization, and stroke. RESULTS: Compared with PCI patients, CABG patients had higher prevalence of 3-vessel disease (P < 0.001), significant LAD involvement (P < 0.001), presence of total occlusions (P = 0.04), collateral circulation (P < 0.001). At 2-year follow-up, MACCE were not different between CABG group and DES-PCI group (OR 1.2; P = 0.6) and, only when the clinical judgment on the revascularization choice was excluded at propensity analysis, DES-PCI increased the risk of 24-month MACCE in total population (OR 1.8; P = 0.04). CONCLUSIONS: For patients with DM and MVD, a clinical judgment-based revascularization by DES-PCI is not associated with worse 2-year outcome compared with CABG. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/19089938/PCI_versus_CABG_for_multivessel_coronary_disease_in_diabetics_ L2 - https://doi.org/10.1002/ccd.21757 DB - PRIME DP - Unbound Medicine ER -