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Medical Treatment and Revascularization Options in Patients With Type 2 Diabetes and Coronary Disease
- Source :
- Journal of the American College of Cardiology. 68(10)
- Publication Year :
- 2015
-
Abstract
- There are scant outcomes data in patients with type 2 diabetes and stable coronary artery disease (CAD) stratified by detailed angiographic burden of CAD or left ventricular ejection fraction (LVEF).This study determined the effect of optimal medical therapy (OMT), with or without percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), on long-term outcomes with respect to LVEF and number of diseased vessels, including proximal left anterior descending artery involvement.A patient-level pooled analysis was undertaken in 3 federally-funded trials. The primary endpoint was the composite of death, myocardial infarction (MI), or stroke, adjusted for trial and randomization strategy.Among 5,034 subjects, 15% had LVEF 50%, 77% had multivessel CAD, and 28% had proximal left anterior descending artery involvement. During a median 4.5-year follow-up, CABG + OMT was superior to PCI + OMT for the primary endpoint (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.59 to 0.85; p = 0.0002), death (HR: 0.76; 95% CI: 0.60 to 0.96; p = 0.024), and MI (HR: 0.50; 95% CI: 0.38 to 0.67; p = 0.0001), but not stroke (HR: 1.54; 95% CI: 0.96 to 2.48; p = 0.074). CABG + OMT was also superior to OMT alone for prevention of the primary endpoint (HR: 0.79; 95% CI: 0.64 to 0.97; p = 0.022) and MI (HR: 0.55; 95% CI: 0.41 to 0.74; p = 0.0001), and was superior to PCI + OMT for the primary endpoint in patients with 3-vessel CAD (HR: 0.72; 95% CI: 0.58 to 0.89; p = 0.002) and normal LVEF (HR: 0.71; 95% CI: 0.58 to 0.87; p = 0.0012). There were no significant differences in OMT versus PCI + OMT.CABG + OMT reduced the primary endpoint during long-term follow-up in patients with type 2 diabetes and stable CAD, supporting this as the preferred management strategy.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
Revascularization
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Internal medicine
medicine
Clinical endpoint
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Prospective Studies
Coronary Artery Bypass
Stroke
Randomized Controlled Trials as Topic
Ejection fraction
business.industry
Percutaneous coronary intervention
Stroke Volume
Middle Aged
medicine.disease
Treatment Outcome
Diabetes Mellitus, Type 2
Conventional PCI
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15583597
- Volume :
- 68
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....6f3cedd0a1f1cebbfc5ac742bb6ab0d8