eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
Current issue Archive Manuscripts accepted About the journal Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
2/2020
vol. 16
 
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abstract:
Original paper

ApPropRiateness - Stanetic of myOcardial revascUlarization assessed by SYNTAX Scores in patients with type 2 diabetes melliTus: the PROUST study*

Bojan M. Stanetic
1, 2
,
Miodrag Ostojic
1, 2, 3, 4
,
Tamara Kovacevic-Preradovic
1, 2
,
Ljiljana Kos
1
,
Kosana Stanetić
2, 5
,
Aleksandra Nikolic
3, 4
,
Milovan Bojic
2, 3
,
Kurt Huber
6, 7

1.
Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
2.
Medical Faculty, University of Banja Luka, Bosnia and Herzegovina
3.
Institute for Cardiovascular diseases Dedinje, Belgrade, Serbia
4.
Medical School, University of Belgrade, Belgrade, Serbia
5.
Primary Health Center, Banja Luka, Bosnia and Herzegovina
6.
Wilhelminenspital, 3rd Medical Department–Cardiology, Vienna, Austria
7.
Sigmund Freud Private University Medical School, Vienna, Austria
Adv Interv Cardiol 2020; 16, 2 (60): 153–161
Online publish date: 2020/06/23
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Introduction
Results of currently available trials have shown divergent outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Current guidelines do not recommend PCI in patients with diabetes and a SYNTAX score ≥ 23.

Aim
To compare all-cause 4-year mortality after revascularization for complex coronary artery disease (CAD) in diabetics.

Material and methods
The study group comprised consecutive patients with three-vessel CAD and/or unprotected left main CAD (≥ 50% diameter stenosis) without major hemodynamic instability, who were treated in two institutions with PCI or referred for CABG.

Results
Out of 342 diabetics, 177 patients underwent PCI and 165 patients were referred for CABG. The incidence of all-cause death was different between diabetics treated with PCI or CABG at 4 years (16/177, 9.0% vs. 26/165, 15.8%, respectively, p = 0.03). The difference was not evident in non-diabetics (PCI: 41/450, 9.1% vs. CABG: 19/249, 7.6%, p = 0.173). In diabetics, there was a higher incidence of all-cause mortality in PCI patients with intermediate-high (≥ 23) SYNTAX scores compared with those with low (0–22) SYNTAX scores (10/56, 17.9% vs. 6/121, 5.0%, respectively, p < 0.01). On the other hand, diabetics who underwent CABG showed similar mortality rates irrespective of the SYNTAX scores (SYNTAX 0–22: 3/29, 10.3%; SYNTAX ≥ 23: 23/136, 11.9%, p = 0.46). In the subgroup analysis, there was no interaction according to presence or absence of left main CAD (p for interaction = 0.12) as well as according to diabetes status (p for interaction = 0.38), whereas gender and SYNTAX scores were differentiators between PCI and CABG with a p for interaction < 0.1.

Conclusions
Our analysis supports recent evidence that diabetes is not a differentiator between PCI and CABG.

keywords:

diabetes mellitus, percutaneous coronary intervention, multivessel disease, SYNTAX score, stable angina pectoris, coronary artery bypass grafting

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