Long-term outcomes after percutaneous coronary intervention relative to bypass surgery in diabetic patients with multivessel coronary artery disease according to clinical presentation

2020 ◽  
Vol 31 (2) ◽  
pp. 174-183
Author(s):  
Yong-Joon Lee ◽  
Sung-Jin Hong ◽  
Byeong-Keuk Kim ◽  
Sanghoon Shin ◽  
Yongsung Suh ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Bypass Surgery ◽  
Clinical Presentation ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Multivessel Coronary Artery Disease ◽  
Long Term Outcomes ◽  
Percutaneous Coronary ◽  
Artery Disease

Real-world referral pattern and outcomes of diabetic patients who undergo revascularization: data from the prospective Multi-vessel Coronary Artery Disease (MULTICAD) Israeli Registry†

2019 ◽  
Vol 56 (2) ◽  
pp. 328-334 ◽  
Author(s):  
Eilon Ram ◽  
Ilan Goldenberg ◽  
Leonid Sternik ◽  
Yael Peled ◽  
Amit Segev ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Term Survival ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Percutaneous Revascularization ◽  
Vessel Coronary Artery

Abstract OBJECTIVES Diabetes mellitus patients with multivessel coronary artery disease present with a poor prognosis. We aimed to explore real-life clinical outcomes of diabetic patients who were referred for coronary revascularization. METHODS We used data from the Multi-vessel Coronary Artery Disease (MULTICAD) Israeli Registry. Using descriptive statistics, Kaplan–Meier, Cox and logistic regression, we described a revascularization referral pattern, short-term outcomes and long-term survival among 475 diabetic patients with multivessel and/or left main disease, 48% of whom underwent surgical and 52% percutaneous revascularization. RESULTS Factors independently associated with referral for surgery included the presence of left main stenosis [odds ratio (OR) 1.89; P = 0.030] and a higher Syntax score (OR 1.15 per point increment; P < 0.001), whereas an older age (OR 1.03 per 1-year increment in age; P = 0.019), prior percutaneous coronary intervention (OR 1.83; P = 0.009) and the presence of renal impairment (OR 2; P = 0.026) were associated with percutaneous coronary intervention referral. At 7 months of follow-up, multivariable analysis did not reveal any difference in mortality risk between the surgical and percutaneous revascularization groups [hazard ratio (HR) 1.23, 95% confidence interval (CI) 0.5–3.04; P = 0.649], whereas after 7 months, surgical revascularization was associated with a significant survival benefit (HR 2.24, 95% CI 1.03–4.87; P = 0.042). CONCLUSIONS Our observation suggests that in a real-world setting, only approximately one-half of diabetic patients with multivessel disease are referred to surgical revascularization despite guideline indications. Surgical compared to percutaneous revascularization in this population was associated with improved long-term survival that became evident 7 months after the revascularization procedure.

scholarly journals Impact of changes in body mass index after percutaneous coronary intervention on long-term outcomes in patients with coronary artery disease

2020 ◽  
Vol 35 (12) ◽  
pp. 1657-1663 ◽  
Author(s):  
Hisanori Yui ◽  
Soichiro Ebisawa ◽  
Takashi Miura ◽  
Chie Nakamura ◽  
Shusaku Maruyama ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Body Mass Index ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Body Mass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Little is known about the impact of changes in body mass index (BMI) after the percutaneous coronary intervention (PCI) on long-term outcomes in patients with coronary artery disease (CAD). Therefore, this study aimed to clarify this issue. We investigated data on CAD obtained from the SHINANO Registry, a prospective, observational, multicenter cohort study, from 2012 to 2013 in Nagano, Japan. One year after PCI, the enrolled patients were divided into the following three groups based on changes in BMI by tertiles: reduced, maintained, and elevated BMI. The associations among the groups and the 4-year outcomes [major adverse cardiac events (MACEs), all-cause death, Q-wave myocardial infarction, and stroke] were examined. Five hundred seventy-two patients were divided into the reduced, maintained, and elevated BMI groups. Over the 4-year follow-up period, the cumulative incidence of MACEs was 10.5% (60 cases). In the Kaplan–Meier analysis, the incidence rates of MACE were significantly higher in the reduced BMI group than in the maintained and elevated BMI groups [17.7% versus (vs.) 7.3% vs. 9.0%, p = 0.004]. Multivariable cox regression analysis showed that the reduced group showed increased risks of MACEs (hazard ratio 2.15; 95% confidence interval 1.29–3.57; p = 0.003). The long-term clinical outcomes of patients with CAD who underwent PCI were affected by the reduction in BMI after PCI. Furthermore, the elevation of BMI after PCI was not a poor prognostic factor.

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