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Article: Everolimus eluting stents versus coronary artery bypass graft surgery for patients with diabetes mellitus and multivessel disease

TitleEverolimus eluting stents versus coronary artery bypass graft surgery for patients with diabetes mellitus and multivessel disease
Authors
KeywordsCoronary Artery Bypass Graft
Diabetes Mellitus
Multivessel Disease
Percutaneous Coronary Intervention
Issue Date2015
Citation
Circulation: Cardiovascular Interventions, 2015, v. 8, article no. e002626 How to Cite?
AbstractBackground-In patients with diabetes mellitus and multivessel disease, coronary artery bypass graft surgery and percutaneous coronary intervention are treatment options. However, there is paucity of data comparing coronary artery bypass graft surgery against newer generation stents. Methods and Results-Patients included in the New York State registries who had diabetes mellitus and underwent isolated coronary artery bypass graft surgery or percutaneous coronary intervention with everolimus eluting stent (EES) for multivessel disease were included. Propensity score matching was used to assemble a cohort with similar baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. Short-term (within 30 days) and long-term outcomes were evaluated. Among 16 089 patients with diabetes mellitus and multivessel disease, 8096 patients with similar propensity scores were included. At short-term, EES was associated with a lower risk of death (hazard ratio [HR] =0.58; 95% confidence interval [CI], 0.34-0.98; P=0.04) and stroke (HR=0.14; 95% CI, 0.06-0.30; P0.0001) but higher risk of MI (HR=2.44; 95% CI, 1.13-5.31; P=0.02). At long-term, EES was associated with a similar risk of death (425 [10.50%] versus 414 [10.23%] events; HR=1.12; 95% CI, 0.96-1.30; P=0.16), a lower risk of stroke (118 [2.92%] versus 157 [3.88%] events; HR=0.76; 95% CI, 0.58-0.99; P=0.04) but a higher risk of MI (260 [6.42%] versus 166 [4.10%] events; HR=1.64; 95% CI, 1.32-2.04; P0.0001) and repeat revascularization (889 [21.96%] versus 421 [10.40%] events; HR=2.42; 95% CI, 2.12-2.76; P0.0001). The higher risk of MI was not seen in the subgroup of EES patients who underwent complete revascularization (HR=1.37; 95% CI, 0.76-2.47; P=0.30). Conclusions-In patients with diabetes mellitus and multivessel disease, EES was associated with lower upfront risk of death and stroke when compared with coronary artery bypass graft surgery. However, at long-term, EES was associated with similar risk of death, a higher risk of MI (in those with incomplete revascularization), and repeat revascularization but a lower risk of stroke. © 2015 American Heart Association, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/221696
ISSN
2015 Impact Factor: 5.706
2015 SCImago Journal Rankings: 3.995

 

DC FieldValueLanguage
dc.contributor.authorBangalore, S-
dc.contributor.authorGuo, Y-
dc.contributor.authorBlecker, S-
dc.contributor.authorSamadashvili, Z-
dc.contributor.authorXu, J-
dc.contributor.authorHannan, EL-
dc.date.accessioned2015-12-04T15:29:10Z-
dc.date.available2015-12-04T15:29:10Z-
dc.date.issued2015-
dc.identifier.citationCirculation: Cardiovascular Interventions, 2015, v. 8, article no. e002626-
dc.identifier.issn1941-7640-
dc.identifier.urihttp://hdl.handle.net/10722/221696-
dc.description.abstractBackground-In patients with diabetes mellitus and multivessel disease, coronary artery bypass graft surgery and percutaneous coronary intervention are treatment options. However, there is paucity of data comparing coronary artery bypass graft surgery against newer generation stents. Methods and Results-Patients included in the New York State registries who had diabetes mellitus and underwent isolated coronary artery bypass graft surgery or percutaneous coronary intervention with everolimus eluting stent (EES) for multivessel disease were included. Propensity score matching was used to assemble a cohort with similar baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes were myocardial infarction (MI), stroke, and repeat revascularization. Short-term (within 30 days) and long-term outcomes were evaluated. Among 16 089 patients with diabetes mellitus and multivessel disease, 8096 patients with similar propensity scores were included. At short-term, EES was associated with a lower risk of death (hazard ratio [HR] =0.58; 95% confidence interval [CI], 0.34-0.98; P=0.04) and stroke (HR=0.14; 95% CI, 0.06-0.30; P0.0001) but higher risk of MI (HR=2.44; 95% CI, 1.13-5.31; P=0.02). At long-term, EES was associated with a similar risk of death (425 [10.50%] versus 414 [10.23%] events; HR=1.12; 95% CI, 0.96-1.30; P=0.16), a lower risk of stroke (118 [2.92%] versus 157 [3.88%] events; HR=0.76; 95% CI, 0.58-0.99; P=0.04) but a higher risk of MI (260 [6.42%] versus 166 [4.10%] events; HR=1.64; 95% CI, 1.32-2.04; P0.0001) and repeat revascularization (889 [21.96%] versus 421 [10.40%] events; HR=2.42; 95% CI, 2.12-2.76; P0.0001). The higher risk of MI was not seen in the subgroup of EES patients who underwent complete revascularization (HR=1.37; 95% CI, 0.76-2.47; P=0.30). Conclusions-In patients with diabetes mellitus and multivessel disease, EES was associated with lower upfront risk of death and stroke when compared with coronary artery bypass graft surgery. However, at long-term, EES was associated with similar risk of death, a higher risk of MI (in those with incomplete revascularization), and repeat revascularization but a lower risk of stroke. © 2015 American Heart Association, Inc.-
dc.languageeng-
dc.relation.ispartofCirculation: Cardiovascular Interventions-
dc.subjectCoronary Artery Bypass Graft-
dc.subjectDiabetes Mellitus-
dc.subjectMultivessel Disease-
dc.subjectPercutaneous Coronary Intervention-
dc.titleEverolimus eluting stents versus coronary artery bypass graft surgery for patients with diabetes mellitus and multivessel disease-
dc.typeArticle-
dc.identifier.emailXu, J: xujf@hku.hk-
dc.identifier.authorityXu, J=rp02086-
dc.identifier.doi10.1161/CIRCINTERVENTIONS.115.002626-
dc.identifier.scopuseid_2-s2.0-84942796647-
dc.identifier.hkuros260479-
dc.identifier.volume8-
dc.identifier.spagearticle no. e002626-
dc.identifier.epagearticle no. e002626-

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