Outcomes of Coronary Revascularization (Percutaneous or Bypass) in Patients With Diabetes Mellitus and Multivessel Coronary Disease
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- 作者：Leia Hee ; Christian J. Mussap ; Lihua Yang ; Rebecca Dignan ; Krishna K. Kadappu ; Craig P. Juergens ; Liza Thomas ; John K. French
- 刊名：The American Journal of Cardiology
- 出版年：2012
- 出版时间：1 September, 2012
- 年：2012
- 卷：110
- 期：5
- 页码：643-648
- 全文大小：882 K
文摘
Clinical outcomes in patients with diabetes mellitus and multivessel disease (MVD) undergoing coronary revascularization have not been extensively evaluated, we sought to examine outcomes in a diabetic cohort of 195 consecutive patients with MVD characterized by SYNTAX scores (SSs) undergoing nonrandomized revascularization, 102 (52 % ) by percutaneous intervention (PCI) and 93 (48 % ) by coronary artery bypass grafting (CABG) at Liverpool Hospital (Sydney, Australia) from June 2006 to March 2010. Clinical outcomes were assessed at a median term of 14 months. The overall median SS was 44, with significantly higher SSs in CABG- than PCI-treated patients (48 vs 39, p <0.0001). There was a similar incidence of all-cause death, nonfatal myocardial infarction and stroke in PCI- and CABG-treated patients (6.1 % vs 8.3 % , p = 0.383; 12 % vs 4.9 % , p = 0.152; 3.1 % vs 3.5 % , p = 0.680 respectively). However, the rates of target vessel revascularization and major adverse coronary and cerebral event were significantly higher in PCI-treated patients than in those undergoing CABG (20 % vs 1.2 % , p <0.0001; 29 % vs 15 % , p = 0.034). Despite a much higher SS, patients who underwent PCI achieved comparable outcomes at 1 year to those with diabetes mellitus and a SS ¡Ý33 as reported in the SYNTAX trial. In conclusion, in this single-center nonrandomized observational study, coronary revascularization by PCI is associated with increased major adverse coronary and cerebral events at 1-year follow-up, predominantly driven by a high rate of target vessel revascularization. Thus, CABG should remain the revascularization procedure of choice for diabetic patients with MVD and high SSs.