CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study
Nathaniel W. Niles, MD*,
Paul D. McGrath, MD, FACC ,
David Malenka, MD, FACC*,
Hebe Quinton, MS*,
David Wennberg, MD ,
Samuel J. Shubrooks, MD, FACC ,
Joan F. Tryzelaar, MD,
Robert Clough, MD||,
Michael J. Hearne, MD, FACC¶,
Felix Hernandez, Jr, MD, FACC||,
Matthew W. Watkins, MD, FACC#,
Gerald T. O’Connor, PhD, FACC* for the Northern New England Cardiovascular Disease Study Group
* Department of Medicine and Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Section of Cardiology, Maine Medical Center, Portland, Maine, USA
Maine Medical Assessment Foundation, Augusta, Maine, USA
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
|| Eastern Maine Medical Center, Bangor, Maine, USA
¶ Catholic Medical Center, Manchester, New Hampshire, USA
# Cardiology Unit, Fletcher Allen Health Care, Burlington, Vermont, USA
Manuscript received May 1, 2000;
revised manuscript received September 25, 2000,
accepted December 6, 2000.
Reprint requests and correspondence: Dr. Nathaniel W. Niles, Cardiology Section, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire 03756
nat.niles{at}hitchcock.org
OBJECTIVES
We sought to assess survival among patients with diabetes and multivessel coronary artery disease (MVD) after percutaneous coronary intervention (PCI) and after coronary artery bypass grafting surgery (CABG).
BACKGROUND
The Bypass Angioplasty Revascularization Investigation (BARI) demonstrated that diabetics with MVD survive longer after initial CABG than after initial PCI. Other randomized trials or observational databases have not conclusively reproduced this result.
METHODS
A large, regional database was linked to the National Death Index to assess five-year mortality. Of 7,159 consecutive patients with diabetes who underwent coronary revascularization in northern New England during 1992 to 1996, 2,766 (38.6%) were similar to those randomized in the BARI trial. Percutaneous coronary intervention was the initial revascularization strategy in 736 patients and CABG in 2,030. Cox proportional hazards regression was used to calculate risk-adjusted hazard ratios (HR) and 95% confidence intervals (CI 95%).
RESULTS
Patients who underwent PCI were younger, had higher ejection fractions and less extensive coronary disease. After adjusting for differences in baseline clinical characteristics, patients with diabetes treated with PCI had significantly greater mortality relative to those undergoing CABG (HR = 1.49; CI 95%: 1.02 to 2.17; p = 0.037). Mortality risk tended to increase more among 1,251 patients with 3VD (HR = 2.02; CI 95%: 1.04 to 3.91; p = 0.038) than among 1,515 patients with 2VD (HR = 1.33; CI 95%: 0.84 to 2.1; p = 0.21).
CONCLUSIONS
In this analysis of a large regional contemporary database of patients with diabetes selected to be similar to those enrolled in the BARI trial, five-year mortality was significantly increased after initial PCI. This supports the BARI conclusion on initial revascularization of patients with diabetes and MVD.
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Abbreviations and Acronyms
| | BARI | = Bypass Angioplasty Revascularization Investigation | | CABG | = coronary artery bypass grafting | | CABRI | = Coronary Angioplasty versus Bypass Revascularization Investigation | | CHF | = congestive heart failure | | CI 95% | = 95% confidence interval | | COPD | = chronic obstructive pulmonary disease | | EAST | = Emory Angioplasty versus Surgery Trial | | HR | = hazard ratio | | MAHI | = Mid America Heart Institute | | MI | = myocardial infarction | | MVD | = multivessel coronary artery disease | | NHLBI | = National Heart, Lung and Blood Institute | | PCI | = percutaneous coronary intervention | | PTCA | = percutaneous transluminal coronary angioplasty | | PVD | = peripheral vascular disease | | RITA | = Randomized Intervention Treatment of Angina | | 2VD | = two-vessel coronary artery disease | | 3VD | = three-vessel coronary artery disease |
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52(24):
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86(4):
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|
|
|
|
|
|
|
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September 9, 2008;
118(11):
1146 - 1154.
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|
|
|
|
|
|
|
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16(4):
331 - 336.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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Long-Term Mortality After Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation Versus Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Artery Disease
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April 22, 2008;
117(16):
2079 - 2086.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. L. Brown, T. M. Sundt III, and B. J. Gersh
Indications for Revascularization
Card. Surg. Adult,
January 1, 2008;
3(2008):
551 - 572.
[Full Text]
|
|
|
|
|
|
|
S. Mohammadi, F. Dagenais, P. Mathieu, J. G. Kingma, D. Doyle, S. Lopez, R. Baillot, J. Perron, E. Charbonneau, E. Dumont, et al.
Long-Term Impact of Diabetes and Its Comorbidities in Patients Undergoing Isolated Primary Coronary Artery Bypass Graft Surgery
Circulation,
September 11, 2007;
116(11_suppl):
I-220 - I-225.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Daemen and P. W. Serruys
Drug-Eluting Stent Update 2007: Part II: Unsettled Issues
Circulation,
August 21, 2007;
116(8):
961 - 968.
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[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al.
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Eur. Heart J. Suppl.,
June 1, 2007;
9(suppl_C):
C3 - C74.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. P Taggart
Coronary revascularisation
BMJ,
March 24, 2007;
334(7594):
593 - 594.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al.
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Eur. Heart J.,
January 1, 2007;
28(1):
88 - 136.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Daemen, H. M. Garcia-Garcia, N. Kukreja, F. Imani, P. P.T. de Jaegere, G. Sianos, R. T. van Domburg, and P. W. Serruys
The long-term value of sirolimus- and paclitaxel-eluting stents over bare metal stents in patients with diabetes mellitus
Eur. Heart J.,
January 1, 2007;
28(1):
26 - 32.
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[PDF]
|
|
|
|
|
|
|
D. P. Taggart
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Ann. Thorac. Surg.,
December 1, 2006;
82(6):
1966 - 1975.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Breeman, M. E. Bertrand, J. P. Ottervanger, S. Hoeks, M. Lenzen, U. Sechtem, V. Legrand, M.-J. de Boer, W. Wijns, E. Boersma, et al.
Diabetes does not influence treatment decisions regarding revascularization in patients with stable coronary artery disease.
Diabetes Care,
September 1, 2006;
29(9):
2003 - 2011.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. B. King III, G. Dangas, J. W. Moses, S. B. King III, G. Dangas, and J. W. Moses
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September 6, 2005;
112(10):
1500 - 1515.
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[PDF]
|
|
|
|
|
|
|
D. P Taggart
Surgery is the best intervention for severe coronary artery disease
BMJ,
April 2, 2005;
330(7494):
785 - 786.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. E. Woods, J. M. Smith, S. Sohail, A. Sarah, and A. Engle
The Influence of Type 2 Diabetes Mellitus in Patients Undergoing Coronary Artery Bypass Graft Surgery: An 8-Year Prospective Cohort Study
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December 1, 2004;
126(6):
1789 - 1795.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Leavitt, L. Sheppard, C. Maloney, R. A. Clough, J. H. Braxton, D. C. Charlesworth, R. M. Weintraub, F. Hernandez, E. M. Olmstead, W. C. Nugent, et al.
Effect of Diabetes and Associated Conditions on Long-Term Survival After Coronary Artery Bypass Graft Surgery
Circulation,
September 14, 2004;
110(11_suppl_1):
II-41 - II-44.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. O'Rourke, H. B. Quinton, W. Piper, F. Hernandez, J. Morton, B. Hettleman, M. Hearne, W. Nugent, G. T. O'Connor, and D. J. Malenka
Survival in patients with peripheral vascular disease after percutaneous coronary intervention and coronary artery bypass graft surgery
Ann. Thorac. Surg.,
August 1, 2004;
78(2):
466 - 470.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Lichtenberg, U. Klima, H. Paeschke, M. Pichlmaier, S. Ringes-Lichtenberg, T. Walles, H. Goerler, and A. Haverich
Impact of diabetes on outcome following isolated minimally invasive bypass grafting of the left anterior descending artery
Ann. Thorac. Surg.,
July 1, 2004;
78(1):
129 - 134.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Brener, B. W. Lytle, I. P. Casserly, J. P. Schneider, E. J. Topol, and M. S. Lauer
Propensity Analysis of Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease and High-Risk Features
Circulation,
May 18, 2004;
109(19):
2290 - 2295.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Moussa, M. B. Leon, D. S. Baim, W. W. O'Neill, J. J. Popma, M. Buchbinder, J. Midwall, C. A. Simonton, E. Keim, P. Wang, et al.
Impact of Sirolimus-Eluting Stents on Outcome in Diabetic Patients: A SIRIUS (SIRolImUS-coated Bx Velocity balloon-expandable stent in the treatment of patients with de novo coronary artery lesions) Substudy
Circulation,
May 18, 2004;
109(19):
2273 - 2278.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. R. Holmes Jr, B. G. Firth, and D. L. Wood
Paradigm shifts in cardiovascular medicine
J. Am. Coll. Cardiol.,
February 18, 2004;
43(4):
507 - 512.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Mathew, B. J. Gersh, B. A. Williams, W. K. Laskey, J. T. Willerson, R. T. Tilbury, B. R. Davis, and D. R. Holmes Jr
Outcomes in Patients With Diabetes Mellitus Undergoing Percutaneous Coronary Intervention in the Current Era: A Report From the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) Trial
Circulation,
February 3, 2004;
109(4):
476 - 480.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. T. Hurst and R. W. Lee
Increased Incidence of Coronary Atherosclerosis in Type 2 Diabetes Mellitus: Mechanisms and Management
Ann Intern Med,
November 18, 2003;
139(10):
824 - 834.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.-H. Mak and D. P. Faxon
Clinical studies on coronary revascularization in patients with type 2 diabetes
Eur. Heart J.,
June 2, 2003;
24(12):
1087 - 1103.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Rumsfeld, D. J. Magid, M. E. Plomondon, J. Sacks, W. Henderson, M. Hlatky, G. Sethi, D. A. Morrison, and Veterans Affairs Angina With Extremely Serious Ope
Health-related quality of life after percutaneous coronary intervention versus coronary bypass surgery in high-risk patients with medically refractory ischemia
J. Am. Coll. Cardiol.,
May 21, 2003;
41(10):
1732 - 1738.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. N. Hoffman, J. A. TenBrook Jr, M. P. Wolf, S. G. Pauker, D. N. Salem, and J. B. Wong
A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes
J. Am. Coll. Cardiol.,
April 16, 2003;
41(8):
1293 - 1304.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. K. McGuire, K. J. Anstrom, and E. D. Peterson
Influence of the Bypass Angioplasty Revascularization Investigation National Heart, Lung, and Blood Institute Diabetic Clinical Alert on Practice Patterns: Results from the National Cardiovascular Network Database
Circulation,
April 15, 2003;
107(14):
1864 - 1870.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. M. Sundt III, B. J. Gersh, and H. C. Smith
Indications for Coronary Revascularization
Card. Surg. Adult,
January 1, 2003;
2(2003):
541 - 559.
[Full Text]
|
|
|
|
|
|
|
Y. J. Woo and T. J. Gardner
Myocardial Revascularization with Cardiopulmonary Bypass
Card. Surg. Adult,
January 1, 2003;
2(2003):
581 - 607.
[Full Text]
|
|
|
|
|
|
|
V. Mathew and D. R. Holmes
Outcomes in diabetics undergoing revascularization: The long and the short of it
J. Am. Coll. Cardiol.,
August 7, 2002;
40(3):
424 - 427.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Ono, J. Kobayashi, Y. Sasako, K. o Bando, O. Tagusari, K. Niwaya, H. Imanaka, T. Nakatani, and S. Kitamura
The impact of diabetic retinopathy on long-term outcome following coronary artery bypass graft surgery
J. Am. Coll. Cardiol.,
August 7, 2002;
40(3):
428 - 436.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Foo and A. D Timmis
Review: Managing the diabetic patient with angina
The British Journal of Diabetes & Vascular Disease,
May 1, 2002;
2(3):
169 - 175.
[Abstract]
[PDF]
|
|
|
|
|
|
|
Insulin resistance and novel markers of cardiovascular disease in 2 diabetes cardiovascular disease in type 2 diabetes: Report of a GSK symposium from the American Diabetes Association Conference, San Francisco, June 15th 2002
The British Journal of Diabetes & Vascular Disease,
May 1, 2002;
2(3_suppl):
1 - S5.
[PDF]
|
|
|
|
|
|
|
P. A Andrews and S. J. Brecker
Premature atherosclerosis associated with diabetic renal disease
The British Journal of Diabetes & Vascular Disease,
March 1, 2002;
2(2):
128 - 129.
[PDF]
|
|
|
|
|
|
|
P. J. Pugh, L. O'Toole, K. S. Channer, D. P. Taggart, A. Banning, K. Channon, M. J. Mack, M. Murtaza, M. Singh, L. Dharmarajan, et al.
Coronary-Artery Bypass Surgery versus Stenting for Multivessel Disease
N. Engl. J. Med.,
November 29, 2001;
345(22):
1641 - 1643.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. B. King III
Coronary artery bypass graft or percutaneous coronary interventions in patients with diabetes: another nail in the coffin or "too close to call?"
J. Am. Coll. Cardiol.,
March 15, 2001;
37(4):
1016 - 1018.
[Full Text]
[PDF]
|
|
|
|
