본문 바로가기
KERD
논문KCI 등재

Comparison of Bypass Surgery with Drug-Eluting Stents in Diabetic Patients with Left Main Coronary Stenosis

Xian Wu Cheng|Hui Song|Yuzi Li|Xiaoxiao Zhao|Yujie Zhou|Like Guan|Guanbin Zheng|Zhehu Jin|Dongmei Shi|Yonghe Guo|Guo-Ping Shi
연세대학교의과대학 (Yonsei University College of Medicine)|2011.11|Yonsei Medical Journal|제52권 제6호|pp. 923-932

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

diabetes mellitusdrug-eluting stentLeft main coronary artery diseasecoronary interventioncoronary-artery bypass grafting
주제분류의학일반

초록

Purpose: Several studies have compared the effects of coronary stenting and coronary-artery bypass grafting (CABG) on left main coronary artery (LMCA) disease. However, there are limited data on the long-term outcomes of these two interventions in diabetic patients. Materials and Methods: We evaluated 56 patients with LMCA stenosis who underwent drug-eluting stent (DES) implantation and 116 patients who underwent CABG in a single hospital in China between January 2004 and December 2006. We compared long-term major adverse cardiac events (death; a “serious outcome” composite of death, myocardial infarction, or stroke; and target-vessel revascularization). Results: In-hospital (30-day) mortality was 0% for the DES group and 3.4% for the CABG group (p=0.31). There was no difference between the two groups in terms of risk of death [hazard ratio for stenting group, 0.49; 95% confidence interval (CI), 0.13-1.63; p=0.55] or risk of serious outcome (hazard ratio for DES group, 1.11; 95% CI, 0.39-1.45; p=0.47). The target-vessel revascularization rate was higher in the DES group than in the CABG group (hazard ratio, 3.67; 95% CI, 1.24-11.06; p=0.018). Conclusion: In this cohort of diabetic patients with LMCA stenosis, there was no difference in composite endpoints between patients receiving DESs and those undergoing CABG. However, stenting was associated with higher rates of target-vessel revascularization than CABG. DES implantation in diabetic patients with LMCA disease was found to be at least as safe as CABG.

Abstract

Purpose: Several studies have compared the effects of coronary stenting and coronary-artery bypass grafting (CABG) on left main coronary artery (LMCA) disease. However, there are limited data on the long-term outcomes of these two interventions in diabetic patients. Materials and Methods: We evaluated 56 patients with LMCA stenosis who underwent drug-eluting stent (DES) implantation and 116 patients who underwent CABG in a single hospital in China between January 2004 and December 2006. We compared long-term major adverse cardiac events (death; a “serious outcome” composite of death, myocardial infarction, or stroke; and target-vessel revascularization). Results: In-hospital (30-day) mortality was 0% for the DES group and 3.4% for the CABG group (p=0.31). There was no difference between the two groups in terms of risk of death [hazard ratio for stenting group, 0.49; 95% confidence interval (CI), 0.13-1.63; p=0.55] or risk of serious outcome (hazard ratio for DES group, 1.11; 95% CI, 0.39-1.45; p=0.47). The target-vessel revascularization rate was higher in the DES group than in the CABG group (hazard ratio, 3.67; 95% CI, 1.24-11.06; p=0.018). Conclusion: In this cohort of diabetic patients with LMCA stenosis, there was no difference in composite endpoints between patients receiving DESs and those undergoing CABG. However, stenting was associated with higher rates of target-vessel revascularization than CABG. DES implantation in diabetic patients with LMCA disease was found to be at least as safe as CABG.

참고문헌 (44)

  1. Caracciolo EA, "Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease. Long-term CASS experience", Circulation, 91, pp.2335~2344 (1995)
  2. Eagle KA, "ACC", AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology, Circulation, pp.2004, 110[DOI]
  3. Colombo A, "Drug-eluting stent update 2007: part III: technique and unapproved", unsettled indications (left main, bifurcations, chronic total occlusions, small vessels and long lesions, saphenous vein grafts, acute myocardial infarctions, and multivessel disease), 2007, pp.116, 1424~1432
  4. Serruys PW, "Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease", N Engl J Med, 360, pp.961~972 (2009)
  5. Bottner RK, "Inverventional Committee of The Society for Cardiovascular Angiography and Interventions. Do the current ACC", AHA guidelines correctly reflect the attitudes and utilization of PCI in patients with unprotected left main coronary artery stenosis, 2005, pp.64, 402~405
  6. Kannel WB, "Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study", Diabetes Care, 2, pp.120~126 (1979)
  7. Stamler J, "Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial", Diabetes Care, 16, pp.434~444 (1993)
  8. Stein B, "Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty", Circulation, 91, pp.979~989 (1995)
  9. Van Belle E, "Patency of percutaneous transluminal coronary angioplasty sites at 6-month angiographic follow-up: a key determinant of survival in diabetics after coronary balloon angioplasty", Circulation, 103, pp.1218~1224 (2001)
  10. Park SJ, "Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: comparison with bare metal stent implantation", J Am Coll Cardiol, 45, pp.351~356 (2005)
  11. Genuth S, "Follow-up report on the diagnosis of diabetes mellitus", Diabetes Care, 26, pp.3160~3167 (2003)
  12. Park SJ, "Elective stenting of unprotected left main coronary artery stenosis: effect of debulking before stenting and intravascular ultrasound guidance", J Am Coll Cardiol, 38, pp.1054~1060 (2001)
  13. Park SJ, "Technical feasibility, safety, and clinical outcome of stenting of unprotected left main coronary artery bifurcation narrowing", Am J Cardiol, 90, pp.374~378 (2002)
  14. Eagle KA, "ACC", AHA 2004 guideline update for coronary artery bypass graft surgery: summary article. A report of the American College of Cardiology, J Am Coll Cardiol, pp.2004, 44[DOI]
  15. Wang ZJ, "Obesity and cardiovascular thrombotic events in patients undergoing percutaneous coronary intervention with drug-eluting stents", Heart, 95, pp.1587~1592 (2009)
  16. Biondi-Zoccai GG, "Impact of routine angiographic follow-up after percutaneous coronary drug-eluting stenting for unprotected left main disease: the Turin Registry", Clin Res Cardiol, 99, pp.235~242 (2010)
  17. Tu JV, "Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario", Circulation, 91, pp.677~684 (1995)
  18. Hirashiki A, "Dobutamine-induced mechanical alternans is a marker of poor prognosis in idiopathic dilated cardiomyopathy", Clin Exp Pharmacol Physiol, 37, pp.1004~1009 (2010)
  19. Cheng CI, "Long-term outcomes of intervention for unprotected left main coronary artery stenosis: coronary stenting vs coronary artery bypass grafting", Circ J, 73, pp.705~712 (2009)
  20. Dubois C, "Results of percutaneous coronary intervention of the unprotected left main coronary artery in 143 patients and comparison of 30-day mortality to results of coronary artery bypass grafting", Am J Cardiol, 101, pp.75~81 (2008)
  21. Seung KB, "Stents versus coronary-artery bypass grafting for left main coronary artery disease", New England Journal of Medicine, 358(17), pp.1781~1792 (2008), Massachusetts Medical Society
  22. Chaitman BR, "Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS)", Am J Cardiol, 48, pp.765~777 (1981)
  23. Eldar M, "Results of percutaneous transluminal angioplasty of the left main coronary artery", Am J Cardiol, 68, pp.255~256 (1991)
  24. O’Keefe JH Jr, "Left main coronary angioplasty: early and late results of 127 acute and elective procedures", Am J Cardiol, 64, pp.144~147 (1989)
  25. Dzavik V, "Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators", Am Heart J, 142, pp.119~126 (2001)
  26. Takagi T, "Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery", Circulation, 106, pp.698~702 (2002)
  27. Sanmartin M, "Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease", Am J Cardiol, 100, pp.970~973 (2007)
  28. Brener SJ, "Comparison of percutaneous versus surgical revascularization of severe unprotected left main coronary stenosis in matched patients", Am J Cardiol, 101, pp.169~172 (2008)
  29. Silvestri M, "Unprotected left main coronary artery stenting: immediate and medium-term outcomes of 140 elective procedures", J Am Coll Cardiol, 35, pp.1543~1550 (2000)
  30. Hu FB, "Intravascular ultrasound-guided directional coronary atherectomy for unprotected left main coronary stenoses with distal bifurcation involvement", Am J Cardiol, 92, pp.936~940 (2003)
  31. Fröbert O, "Differences in restenosis rate with different drug-eluting stents in patients with and without diabetes mellitus: a report from the SCAAR (Swedish Angiography and Angioplasty Registry)", J Am Coll Cardiol, 53, pp.1660~1667 (2009)
  32. Farkouh ME, "Design of the Future REvascularization Evaluation in patients with Diabetes mellitus: optimal management of Multivessel disease (FREEDOM) Trial", Am Heart J, 155, pp.215~223 (2008)
  33. Park DW, "Long-Term Safety and Efficacy of Stenting Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease 5-Year Results From the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) Registry", JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 56(2), pp.117~124 (2010), ELSEVIER SCIENCE INC
  34. Park DW, "Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry", J Am Coll Cardiol, 56, pp.1366~1375 (2010)
  35. Morice MC, "Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial", Circulation, 121, pp.2645~2653 (2010)
  36. Kim YH, "Impact of the extent of coronary artery disease on outcomes after revascularization for unprotected left main coronary artery stenosis", J Am Coll Cardiol, 55, pp.2544~2552 (2010)
  37. Sheiban I, "Impact of diabetes mellitus on early and long-term results of percutaneous drug-eluting stent implantation for unprotected left main coronary disease", J Cardiovasc Med (Hagerstown), 9, pp.1246~1253 (2008)
  38. Meliga E, "Diabetic patients treated for unprotected left main coronary artery disease with drug eluting stents: a 3-year clinical outcome study. The diabetes and drug eluting stent for LeFT main registry (D-DELFT)", EuroIntervention, 4, pp.77~83 (2008)
  39. Banning AP, "Diabetic and nondiabetic patients with left main and", or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents, 2010, pp.55, 1067~1075
  40. Kim WJ, "Impact of diabetes mellitus on the treatment effect of percutaneous or surgical revascularization for patients with unprotected left main coronary artery disease: a subgroup analysis of the MAIN-COMPARE study", JACC Cardiovasc Interv, 2, pp.956~963 (2009)
  41. Sousa JE, "Four-year angiographic and intravascular ultrasound follow-up of patients treated with sirolimus-eluting stents", Circulation, 111, pp.2326~2329 (2005)
  42. Kuntz RE, "Importance of considering atherosclerosis progression when choosing a coronary revascularization strategy: the diabetes-percutaneous transluminal coronary angioplasty dilemma", Circulation, 99, pp.847~851 (1999)
  43. Lee MS, "Comparison of coronary artery bypass surgery with percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease", J Am Coll Cardiol, 47, pp.864~870 (2006)
  44. Chieffo A, "Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-center experience", Circulation, 113, pp.2542~2547 (2006)

관련 논문AI추천

Stenting versus Bypass Surgery for the Treatment of Left Main Coronary Artery Disease박승정연세대학교의과대학 · Yonsei Medical Journal2009 · 제50권 제6호Multivessel stenting versus coronary bypass surgery,which is better approach inpatients with diabetes mellitus?박승정대한내과학회 · 대한내과학회지2003 · 제65권 제2호당뇨병 환자에서 관상동맥 우회술과 관상동맥 스텐트 시술 후장기 임상 결과김원, 강정채, 김상형, 김주한, 류제영, 박종춘, 심두선, 안병희, 안영근, 염주협, 정명호, 조정관대한내과학회 · 대한내과학회지2003 · 제65권 제2호Five-year clinical outcomes of drug-eluting stents according to on-label and off-label useChan-Hee Lee, Dong-Gu Shin, Jang-Won Son, Jeong-Hwan Cho, Jong-Seon Park, Kyu-Hwan Park, Ung Kim, Young Jo Kim대한내과학회 · The Korean Journal of Internal Medicine2016 · 제31권 제4호Two-year clinical outcomes in stable angina and acute coronary syndrome after percutaneous coronary intervention of left main coronary artery disease김민철, 안영근, 정명호, 조경훈, 홍영준, Dae Young Hyun, Doo Sun Sim, Hae Chang Jeong, Hyun Kuk Kim, Jung Chaee Kang, Jun Han Kim, Keun Ho Park, Yun Ah Jeong대한내과학회 · The Korean Journal of Internal Medicine2016 · 제31권 제6호Drug-Coated Balloons for De Novo Coronary Artery Lesions: A Meta-Analysis of Randomized Clinical TrialsDejin Wang, Hongliang Tian, Qilei Wang, Tianxiao Yang, Xiqian Wang, Yuanzhen Su연세대학교의과대학 · Yonsei Medical Journal2023 · 제64권 제10호

이 간행물의 다른 논문 (17건)

Multidrug-Resistant Acinetobacter spp.: Increasingly Problematic Nosocomial Pathogens정석훈, 용동은, 이경원, 정윤섭pp. 879-891Glutamine as an Immunonutrient김혜영pp. 892-897Anemia in Elderly Koreans이종화pp. 909-913The Assessment of Routine Electroencephalography in Patients with Altered Mental Status서권덕, 최영철, 김원주pp. 933-938Gender Differences in Relationship between Fat-Free Mass Index and Fat Mass Index among Korean Children Using Body Composition Chart정소정, 박기호, 김교순, 김명현, HyeongGeun Parkpp. 948-952
원문 보기