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Bypass surgery or stenting for left main coronary artery disease in patients with diabetes
- Source :
- Journal of the American College of Cardiology, 73(13), 1616-1628. Elsevier Inc.
- Publication Year :
- 2019
- Publisher :
- Elsevier, 2019.
-
Abstract
- Background The randomized EXCEL (Evaluation of XIENCE versus Coronary ArteryBypass Surgeryfor Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint ofdeath,myocardial infarction(MI), orstrokein patients with left maincoronary artery disease(LMCAD) and site-assessed low or intermediateSYNTAX scorestreated withpercutaneous coronary intervention(PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-riskpatients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown. Objectives In this pre-specifiedsubgroup analysisfrom the EXCEL trial, the authors sought to examine the effect ofdiabetesin patients with LMCAD treated with PCI versus CABG. Methods Patients (N=1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores≤32) were randomized 1:1 to PCI with everolimus-elutingstentsversus CABG, stratified by the presence ofdiabetes. The primary endpoint was the rate of a composite of all-causedeath,stroke, or MI at 3 years. Outcomes were examined in patients with (n=554) and without (n=1,350) diabetes. Results The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p< 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%, respectively;hazard ratio: 1.03; 95%confidence interval: 0.71 to 1.50; p=0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively;hazard ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p=0.89). All-cause death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p=0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p=0.22) or other endpoints, including the 3-year primary endpoint (p=0.82) or the major secondary endpoints of death, MI, or stroke at 30days (p=0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p=0.65). Conclusions In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediateSYNTAX scores.(Evaluation of XIENCE versusCoronary Artery BypassSurgery for Effectiveness of Left MainRevascularization[EXCEL];NCT01205776)
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
Revascularization
Diabetes Complications
03 medical and health sciences
Coronary artery bypass surgery
Percutaneous Coronary Intervention
0302 clinical medicine
SDG 3 - Good Health and Well-being
Internal medicine
medicine
Clinical endpoint
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Coronary Artery Bypass
Stroke
Aged
business.industry
Percutaneous coronary intervention
Middle Aged
medicine.disease
surgical procedures, operative
Bypass surgery
Conventional PCI
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology, 73(13), 1616-1628. Elsevier Inc.
- Accession number :
- edsair.doi.dedup.....b6f7f1942babed5dda4ad131591eb847