Firdovsi IBRAHİMOV, Latife KAYIKÇIOĞLU, Shafa SHAHBAZOVA, Isfendiyar ISMAYİLOV, Oktay MUSAYEV, Kamran MUSAYEV, Shahane ELESGERLİ

Akut koroner sendromlu diyabetik hastalarda aort-koroner bypass cerrahisi ile yeni nesil ilaç salınımlı stentlerle uygulanan perkütan koroner girişimin erken ve uzun dönem sonuçlarının karşılaştırılması

Amaç: Bu çalışmanın amacı diyabetik olgularda akut koroner sendrom (AKS) sırasında koroner arter baypas greft (KABG) ve Perkütan koroner girişim (PKG) (yeni nesil ilaç salınımlı stentlerle) uygulanmasının sonuçları arasındakifarkı belirlemekti. Gereç ve Yöntem: Tek merkezde 2 yıllık dönemde AKS ile başvuran 405 diyabetik hastayı retrospektif olarak değerlendirdik. Hastalar 5 yıl boyunca takip edildi. Tüm nedenlerle ilişkili ölüm, kardiyak ölüm, miyokard enfarktüsü, inme, revaskülarizasyon ve stent trombozu gibi tüm klinik olaylar buna göre kaydedildi. Bulgular: AKS'li 1643 hastanın 405'i diyabetli hastayı inceledik. Bunlardan 183'ü (% 45.1) PKG grubuna, 222'si (% 54.8) KABG grubuna dahil edildi. 5 yıllık takip sırasında, PKG grubunda 31 hastada (% 16.9) ve KABG grubunda 33 hastada (% 14.9) ölüm, MI ve inme gibi primer son noktalar gözlendi. İki grup arasında primer sonlanım noktaları arasında fark yoktu. 5 yıl boyunca tüm neden mortalite PKGI grubunda 17 hastada (% 9.8), KABG grubunda 20 hastada (% 9.1) gözlendi. Sonuç: 5 yıllık takip sırasında PKG ve KABG grupları arasında tüm nedenlere bağlı mortalite açısından fark yoktu. Tekrarlanan revaskülarizasyon ve miyokard enfarktüsü, PKG grubunda KABG grubuna göre daha yüksekti. Buna karşılık inme oranları KABG grubunda daha yüksekti.

Comparison of the early and long-term results of aortic-coronary bypass surgery and percutaneous coronary intervention with new generation drug-eluting stents in diabetic patients with acute coronary syndrome

Purpose: The aim of this study was to determine the difference between patients undergoing coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) (with new generation drug-eluting stents) who had diabetes mellitus during the course of an acute coronary syndrome (ACS). Materials and Methods: We carried out a retrospective evaluation of 405 diabetic patients admitted with an ACS during the period of 2 years in a single-center. Patients were followed for 5 years. All clinical incidents, such as death, cardiac death, myocardial infarction, stroke, revascularization, and stent thrombosis were recorded Results: We examined 405 patients with diabetes out of 1643 patients with ACS. Of these, 183 (45.1%) were included in the PCI group and 222 (54.8%) were in the CABG group. During 5-years follow-up, primary endpoints including death, MI, and stroke were observed in 31 patients (16.9%) in the PCI group and in 33 patients (14.9%) in the CABG group. There was no difference between the two groups in terms of primary endpoints. All-cause mortality during 5-years was observed in 17 patients (9.8%) in the PCI, 20 (9.1%) in the CABG group. Conclusion: There was no difference in all-cause mortality between the PCI and the CABG groups during 5-year follow-up. Repeated revascularization and myocardial infarction were higher in the PCI group and the stroke rates were higher in the CABG group.

Keywords:

acute coronary syndrome,

PDF

___

1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4-14.
2. Luscher TF, Creager MA, Beckman JA, Cosentino F. Diabetes and vascular disease. Pathophysiology, clinical consequences and medical therapy. Part II. Circulation. 2003;108:1655–61.
3. Moreno PR, Murcia AM, Palacios IF, Leon MN, Bernardi VH, Fuster V et al. Coronary composition and macrophage infiltration in atherectomy specimens from patients with diabetes mellitus. Circulation. 2000;102:2180–84.
4. Marso SP, Mercado N, Maehara A, Weisz G, Mintz GS, McPherson J et al. Plaque composition and clinical outcomes in acute coronary syndrome patients with metabolic syndrome or diabetes. JACC Cardiovasc Imaging. 2012;5:S42–52.
5. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U et al.. Guidelines on myocardial Revascularization. Eur Heart J. 2019;40:87-165.
6. Ledru F, Ducimetiere P, Battaglia S, Courbon D, Beverelli F, Guize L et al. New diagnostic criteria for diabetes and coronary artery disease. Insights from an angiographic study. J Am Coll Cardiol. 2001;37:1543– 50.
7. Peter L. 8 edition. Single Volume. Braunwald's Heart Disease. A Textbook of Cardiovascular Medicine. Baltimore, Saunders, 2007.
8. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. ESH/ESC Guidelines for the management of arterial hypertension. Eur Heart J. 2013;34:2159–19.
9. Ryde ́n L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N et al. ESC Guidelines on diabetes, pre- diabetes and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34:3035–87.
10. Reiner Z, Catapano AL, Backer GD, Graham l, Taskinen MR, Wiklun O et al. ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2011;32:1769–1818.
11. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ et al. et al. SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961– 72.
12. xxxLang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al, Eur Heart J– Cardiovasc Imaging. 2015;16:233–71.
13. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367:2375–84.
14. Dangas GD, Farkouh ME, Sleeper LA, Yang M, Mikkel MS, Macaya C et al. FREEDOM Investigators. Long-term outcome of PCI versus CABG in insulin and non-insulin-treated diabetic patients. Results from the FREEDOM trial. J Am Coll Cardiol. 2014;64:1189–97.
15. Kamalesh M, Sharp TG, Tang XC, Shunk K, Ward HB, Walsh J et al. CARDS Investigators VA. Percutaneous coronary intervention versus coronary bypass surgery in United States veterans with diabetes. J Am Coll Cardiol. 2013;61:808–16.
16. Silber S, Windecker S, Vranckx P, Serruys PW. RESOLUTE All Comers investigators. Lancet. 2011;377:1241-7.
17. Park SJ, Ahn JM, Kim YH, Park DW, Yun SC, Lee JY et al. BEST Trial Investigators. Trial of evero limus- eluting stents or bypass surgery for coronary disease. N Engl J Med. 2015;372:1204–12.
18. Hakeem A, Garg N, Bhatti S, Rajpurohit N, Ahmed Z, Uretsky BF et al. Effectiveness of percutaneous coronary intervention with drug-eluting stents compared with bypass surgery in diabetics with multivessel coronary disease. J Am Heart Assoc. 2013;2:e000354.
19. Bangalore S, Guo Y, Samadashvili Z, Blecker S, Xu J, Hannan EL et al. Everolimus eluting stents versus coronary artery bypass graft surgery for patients with diabetes mellitus and multivessel disease. Circ Cardiovasc Interv 2015;8:e002626.
20. Herbison P, Wong CK. Has the difference in mortality between percutaneous coronary intervention and coronary artery bypass grafting in people with heart disease and diabetes changed over the years? A systematic review and metaregression. BMJ Open. 2015;5:e010055.
21. Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease. A pooled analysis of individual patient data. Lancet. 2018;391:939-48.
22. Ramanathan K, Abel JG, Park JE, Fung A, Mathew V, Taylor CM et al. Surgical versus percutaneous coronary revascularization in patients with diabetes and acute coronary syndromes. J Am Coll Cardiol. 2017;70:2995–3006.
23. Head SJ, Davierwala PM, Serruys PW, Redwood SR, Colombo A, Mack MJ et al. Coronary artery bypass grafting vs. percutaneous coronary intervention for patients with three-vessel disease: final five-year follow-up of the SYNTAX trial. Eur Heart J. 2014;35:2821-30.
24. Adrian B, Stephen W, Marie-Claude M, A Pieter K, Friedrich WM, Sergio B et al. Diabetic and Nondiabetic Patients With Left Main and/or 3-Vessel Coronary Artery Disease Comparison of Outcomes With Cardiac Surgery and Paclitaxel-Eluting Stents. J Am Coll Cardiol. 2010 16;55:1067-75.
25. Palmerini T, Biondi-Zoccai G, Reggiani LB, Sangiorgi D, Alessi L, De Servi S et al. Risk of stroke with coronary artery bypass graft surgery compared with percutaneous coronary intervention. J Am Coll Cardiol. 2012;60:798-805.
26. Fuster V, Farkouh ME. Decision making regarding revascularization of patients with type 2 diabetes mellitus and cardiovascular disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial. Circulation. 2010;121:2450-2.