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Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents.
J Am Coll Cardiol. 2010 Mar 16; 55(11):1067-75.JACC

Abstract

OBJECTIVES

This study was designed to compare contemporary surgical revascularization (coronary artery bypass graft surgery [CABG]) versus TAXUS Express (Boston Scientific, Natick, Massachusetts) paclitaxel-eluting stents (PES) in diabetic and nondiabetic patients with left main and/or 3-vessel disease.

BACKGROUND

Although the prevalence of diabetes mellitus is increasing, the optimal coronary revascularization strategy in diabetic patients with complex multivessel disease remains controversial.

METHODS

The SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) study randomly assigned 1,800 patients (452 with medically treated diabetes) to receive PES or CABG.

RESULTS

The overall 1-year major adverse cardiac and cerebrovascular event rate was higher among diabetic patients treated with PES compared with CABG, but the revascularization method did not impact the death/stroke/myocardial infarction rate for nondiabetic patients (6.8% CABG vs. 6.8% PES, p = 0.97) or for diabetic patients (10.3% CABG vs. 10.1% PES, p = 0.96). The presence of diabetes was associated with significantly increased mortality after either revascularization treatment. The incidence of stroke was higher among nondiabetic patients after CABG (2.2% vs. PES 0.5%, p = 0.006). Compared with CABG, mortality was higher after PES use for diabetic patients with highly complex lesions (4.1% vs. 13.5%, p = 0.04). Revascularization with PES resulted in higher repeat revascularization for nondiabetic patients (5.7% vs. 11.1%, p < 0.001) and diabetic patients (6.4% vs. 20.3%, p < 0.001).

CONCLUSIONS

Subgroup analyses suggest that the 1-year major adverse cardiac and cerebrovascular event rate is higher among diabetic patients with left main and/or 3-vessel disease treated with PES compared with CABG, driven by an increase in repeat revascularization. However, the composite safety end point (death/stroke/myocardial infarction) is comparable between the 2 treatment options for diabetic and nondiabetic patients. Although further study is needed, these exploratory results may extend the evidence for PES use in selected patients with less complex left main and/or 3-vessel lesions. (SYNergy Between PCI With TAXus and Cardiac Surgery [SYNTAX]; NCT00114972).

Authors+Show Affiliations

Cardiology Department, John Radcliffe Hospital, Oxford, UK. adrian.banning@orh.nhs.ukNo 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 availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20079596

Citation

Banning, Adrian P., et al. "Diabetic and Nondiabetic Patients With Left Main And/or 3-vessel Coronary Artery Disease: Comparison of Outcomes With Cardiac Surgery and Paclitaxel-eluting Stents." Journal of the American College of Cardiology, vol. 55, no. 11, 2010, pp. 1067-75.
Banning AP, Westaby S, Morice MC, et al. Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol. 2010;55(11):1067-75.
Banning, A. P., Westaby, S., Morice, M. C., Kappetein, A. P., Mohr, F. W., Berti, S., Glauber, M., Kellett, M. A., Kramer, R. S., Leadley, K., Dawkins, K. D., & Serruys, P. W. (2010). Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. Journal of the American College of Cardiology, 55(11), 1067-75. https://doi.org/10.1016/j.jacc.2009.09.057
Banning AP, et al. Diabetic and Nondiabetic Patients With Left Main And/or 3-vessel Coronary Artery Disease: Comparison of Outcomes With Cardiac Surgery and Paclitaxel-eluting Stents. J Am Coll Cardiol. 2010 Mar 16;55(11):1067-75. PubMed PMID: 20079596.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. AU - Banning,Adrian P, AU - Westaby,Stephen, AU - Morice,Marie-Claude, AU - Kappetein,A Pieter, AU - Mohr,Friedrich W, AU - Berti,Sergio, AU - Glauber,Mattia, AU - Kellett,Mirle A, AU - Kramer,Robert S, AU - Leadley,Katrin, AU - Dawkins,Keith D, AU - Serruys,Patrick W, Y1 - 2010/01/14/ PY - 2009/06/08/received PY - 2009/09/16/revised PY - 2009/09/30/accepted PY - 2010/1/19/entrez PY - 2010/1/19/pubmed PY - 2010/4/13/medline SP - 1067 EP - 75 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 55 IS - 11 N2 - OBJECTIVES: This study was designed to compare contemporary surgical revascularization (coronary artery bypass graft surgery [CABG]) versus TAXUS Express (Boston Scientific, Natick, Massachusetts) paclitaxel-eluting stents (PES) in diabetic and nondiabetic patients with left main and/or 3-vessel disease. BACKGROUND: Although the prevalence of diabetes mellitus is increasing, the optimal coronary revascularization strategy in diabetic patients with complex multivessel disease remains controversial. METHODS: The SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) study randomly assigned 1,800 patients (452 with medically treated diabetes) to receive PES or CABG. RESULTS: The overall 1-year major adverse cardiac and cerebrovascular event rate was higher among diabetic patients treated with PES compared with CABG, but the revascularization method did not impact the death/stroke/myocardial infarction rate for nondiabetic patients (6.8% CABG vs. 6.8% PES, p = 0.97) or for diabetic patients (10.3% CABG vs. 10.1% PES, p = 0.96). The presence of diabetes was associated with significantly increased mortality after either revascularization treatment. The incidence of stroke was higher among nondiabetic patients after CABG (2.2% vs. PES 0.5%, p = 0.006). Compared with CABG, mortality was higher after PES use for diabetic patients with highly complex lesions (4.1% vs. 13.5%, p = 0.04). Revascularization with PES resulted in higher repeat revascularization for nondiabetic patients (5.7% vs. 11.1%, p < 0.001) and diabetic patients (6.4% vs. 20.3%, p < 0.001). CONCLUSIONS: Subgroup analyses suggest that the 1-year major adverse cardiac and cerebrovascular event rate is higher among diabetic patients with left main and/or 3-vessel disease treated with PES compared with CABG, driven by an increase in repeat revascularization. However, the composite safety end point (death/stroke/myocardial infarction) is comparable between the 2 treatment options for diabetic and nondiabetic patients. Although further study is needed, these exploratory results may extend the evidence for PES use in selected patients with less complex left main and/or 3-vessel lesions. (SYNergy Between PCI With TAXus and Cardiac Surgery [SYNTAX]; NCT00114972). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/20079596/Diabetic_and_nondiabetic_patients_with_left_main_and/or_3_vessel_coronary_artery_disease:_comparison_of_outcomes_with_cardiac_surgery_and_paclitaxel_eluting_stents_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)04074-1 DB - PRIME DP - Unbound Medicine ER -