PCI versus CABG for multivessel coronary disease in diabetics.

To explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in diabetic patients with multivessel disease (MVD) compared with coronary artery bypass graft (CABG), when it is based on clinical judgment. Diabetes mellitus (DM) is a major risk factor for poor outcome after PCI. However, PCI may result in better outcome if the choice of revascularization (PCI versus CABG) is based on the physician decision, rather than randomization. Limited experiences have compared revascularization by DES-PCI versus CABG in DM patients with MVD. From August 2004 to August 2005, 220 consecutive DM patients with MVD underwent DES-PCI (93) or CABG (127) at our Institution. The type of revascularization was dependent on patient and/or physician choice. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, repeat coronary revascularization, and stroke. Compared with PCI patients, CABG patients had higher prevalence of 3-vessel disease (P < 0.001), significant LAD involvement (P < 0.001), presence of total occlusions (P = 0.04), collateral circulation (P < 0.001). At 2-year follow-up, MACCE were not different between CABG group and DES-PCI group (OR 1.2; P = 0.6) and, only when the clinical judgment on the revascularization choice was excluded at propensity analysis, DES-PCI increased the risk of 24-month MACCE in total population (OR 1.8; P = 0.04). For patients with DM and MVD, a clinical judgment-based revascularization by DES-PCI is not associated with worse 2-year outcome compared with CABG.

Tarantini G ，Ramondo A ，Napodano M ，Favaretto E ，Gardin A ，Bilato C ，Nesseris G ，Tarzia V ，Cademartiri F ，Gerosa G ，Iliceto S ... -  《-》

Complete versus incomplete revascularization in patients with multivessel disease undergoing percutaneous coronary intervention with drug-eluting stents.

To investigate the long-term prognostic implications of complete versus incomplete revascularization in multivessel coronary artery disease (MVD) patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Coronary artery bypass grafting (CABG) in patients with MVD provides better outcomes when complete revascularization is achieved. There is a paucity of data on the outcomes of complete versus incomplete revascularization of MVD patients undergoing PCI, and currently there is no data available with DES. Patients with MVD undergoing PCI with DES (sirolimus- or paclitaxel-eluting stent) were included. Comparisons of long-term outcomes between completely versus incompletely revascularized patients were made. The primary outcome measure was the composite of cardiac death, nonfatal myocardial infarction (MI), or any revascularization. Secondary endpoints were the components of the composite endpoint. A total of 508 patients were considered for this analysis: 212 (41.7%) and 296 (58.3%) had complete and incomplete revascularization, respectively. The median follow-up was 27.0 (interquartile range: 23.0-37.1) months. After adjusting for baseline characteristics, the hazard ratio (HR, 95% confidence interval) for complete revascularization was 0.43 (0.29-0.63, P < 0.0001) for the primary composite endpoint. Complete revascularization was associated with better outcomes for components of the composite endpoint: 0.37 (0.15-0.92, P = 0.03) for cardiac death, 0.34 (0.16-0.75 P = 0.008) for the composite of cardiac death or MI and 0.45 (0.29-0.69, P = 0.0003) for any repeat revascularization. This association was confirmed in a propensity-matched population. Complete revascularization with DES of MVD patients is associated with lower rates of long-term adverse events.

Tamburino C ，Angiolillo DJ ，Capranzano P ，Dimopoulos K ，La Manna A ，Barbagallo R ，Tagliareni F ，Mangiafico S ，Guzman LA ，Galassi AR ，Bass TA ... -  《-》

CABG versus DES PCI in diabetics with multivessel disease: back to the BARI registry.

Hillegass W 《-》

Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial.

Daemen J ，Kuck KH ，Macaya C ，LeGrand V ，Vrolix M ，Carrie D ，Sheiban I ，Suttorp MJ ，Vranckx P ，Rademaker T ，Goedhart D ，Schuijer M ，Wittebols K ，Macours N ，Stoll HP ，Serruys PW ，ARTS-II Investigators ... -  《-》

Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.

Rodés-Cabau J ，Deblois J ，Bertrand OF ，Mohammadi S ，Courtis J ，Larose E ，Dagenais F ，Déry JP ，Mathieu P ，Rousseau M ，Barbeau G ，Baillot R ，Gleeton O ，Perron J ，Nguyen CM ，Roy L ，Doyle D ，De Larochellière R ，Bogaty P ，Voisine P ... -  《-》