Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome.
BACKGROUND: Diabetes mellitus increases adverse outcomes after coronary revascularization; however, the impact of metabolic syndrome is unclear. We examined the impact of diabetes and metabolic syndrome on coronary artery bypass graft surgery (CABG) and stenting outcomes to determine the optimal re...
| Päätekijät: | , , , , , , , , , , , |
|---|---|
| Aineistotyyppi: | Journal article |
| Kieli: | English |
| Julkaistu: |
2011
|
| _version_ | 1826299869070884864 |
|---|---|
| author | Mack, M Banning, A Serruys, P Morice, M Taeymans, Y Van Nooten, G Possati, G Crea, F Hood, K Leadley, K Dawkins, K Kappetein, A |
| author_facet | Mack, M Banning, A Serruys, P Morice, M Taeymans, Y Van Nooten, G Possati, G Crea, F Hood, K Leadley, K Dawkins, K Kappetein, A |
| author_sort | Mack, M |
| collection | OXFORD |
| description | BACKGROUND: Diabetes mellitus increases adverse outcomes after coronary revascularization; however, the impact of metabolic syndrome is unclear. We examined the impact of diabetes and metabolic syndrome on coronary artery bypass graft surgery (CABG) and stenting outcomes to determine the optimal revascularization option for the treatment of complex coronary artery disease. METHODS: Patients (n = 1,800) with left main or three-vessel disease or both were randomly allocated to treatment with a TAXUS Express(2) paclitaxel-eluting stent (PES) or CABG, and were included in predefined nondiabetic (n = 1,348) or diabetic subgroups (n = 452); 258 patients with diabetes also had metabolic syndrome. RESULTS: Among diabetic patients, the 3-year major adverse cardiac and cerebrovascular event (MACCE) rate (22.9% CABG, 37.0% PES; p = 0.002) and revascularization rate (12.9% CABG, 28.0% PES; p < 0.001) were higher after PES treatment. Diabetes increased MACCE rates among PES-treated patients, but had little impact on results after CABG. Compared with CABG, PES treatment yielded comparable MACCE in diabetic patients (30.5% versus 29.8%, p =0.98) and nondiabetic patients (20.2% versus 20.3%, p =0.99) with low Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) study scores of 22 or less. For patients with SYNTAX Scores of 33 or greater, MACCE rates were lower with CABG (18.5% versus 45.9%, p < 0.001 diabetic; 19.8% versus 30.0%, p = 0.01 nondiabetic). Metabolic syndrome did not significantly predict MACCE or repeat revascularization. CONCLUSIONS: These exploratory analyses suggest that among diabetic patients with complex left main or three-vessel disease, or both, 3-year MACCE is higher after PES compared with CABG. Although PES is a potential treatment option in patients with less complex lesions, CABG should be the revascularization option of choice for patients with more complex anatomic disease, especially with concurrent diabetes. Metabolic syndrome had little impact on 3-year outcomes. |
| first_indexed | 2024-03-07T05:08:31Z |
| format | Journal article |
| id | oxford-uuid:dabfd86c-87e1-439e-b362-ab2b2b5b0776 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:08:31Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:dabfd86c-87e1-439e-b362-ab2b2b5b07762022-03-27T09:05:31ZBypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:dabfd86c-87e1-439e-b362-ab2b2b5b0776EnglishSymplectic Elements at Oxford2011Mack, MBanning, ASerruys, PMorice, MTaeymans, YVan Nooten, GPossati, GCrea, FHood, KLeadley, KDawkins, KKappetein, A BACKGROUND: Diabetes mellitus increases adverse outcomes after coronary revascularization; however, the impact of metabolic syndrome is unclear. We examined the impact of diabetes and metabolic syndrome on coronary artery bypass graft surgery (CABG) and stenting outcomes to determine the optimal revascularization option for the treatment of complex coronary artery disease. METHODS: Patients (n = 1,800) with left main or three-vessel disease or both were randomly allocated to treatment with a TAXUS Express(2) paclitaxel-eluting stent (PES) or CABG, and were included in predefined nondiabetic (n = 1,348) or diabetic subgroups (n = 452); 258 patients with diabetes also had metabolic syndrome. RESULTS: Among diabetic patients, the 3-year major adverse cardiac and cerebrovascular event (MACCE) rate (22.9% CABG, 37.0% PES; p = 0.002) and revascularization rate (12.9% CABG, 28.0% PES; p < 0.001) were higher after PES treatment. Diabetes increased MACCE rates among PES-treated patients, but had little impact on results after CABG. Compared with CABG, PES treatment yielded comparable MACCE in diabetic patients (30.5% versus 29.8%, p =0.98) and nondiabetic patients (20.2% versus 20.3%, p =0.99) with low Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) study scores of 22 or less. For patients with SYNTAX Scores of 33 or greater, MACCE rates were lower with CABG (18.5% versus 45.9%, p < 0.001 diabetic; 19.8% versus 30.0%, p = 0.01 nondiabetic). Metabolic syndrome did not significantly predict MACCE or repeat revascularization. CONCLUSIONS: These exploratory analyses suggest that among diabetic patients with complex left main or three-vessel disease, or both, 3-year MACCE is higher after PES compared with CABG. Although PES is a potential treatment option in patients with less complex lesions, CABG should be the revascularization option of choice for patients with more complex anatomic disease, especially with concurrent diabetes. Metabolic syndrome had little impact on 3-year outcomes. |
| spellingShingle | Mack, M Banning, A Serruys, P Morice, M Taeymans, Y Van Nooten, G Possati, G Crea, F Hood, K Leadley, K Dawkins, K Kappetein, A Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. |
| title | Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. |
| title_full | Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. |
| title_fullStr | Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. |
| title_full_unstemmed | Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. |
| title_short | Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. |
| title_sort | bypass versus drug eluting stents at three years in syntax patients with diabetes mellitus or metabolic syndrome |
| work_keys_str_mv | AT mackm bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT banninga bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT serruysp bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT moricem bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT taeymansy bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT vannooteng bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT possatig bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT creaf bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT hoodk bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT leadleyk bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT dawkinsk bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome AT kappeteina bypassversusdrugelutingstentsatthreeyearsinsyntaxpatientswithdiabetesmellitusormetabolicsyndrome |