Long-term prognosis of complete percutaneous coronary revascularisation in patients with diabetes with multivessel disease
Open accessAbstract
Objective: There is a paucity of data on the impact of complete revascularisation (CR) following percutaneous coronary intervention (PCI) among patients with diabetes with multivessel coronary disease. In this study, we assess the impact of CR, using a relatively simple anatomical definition, on long-term outcomes (median follow-up 7.9 years) in patients with diabetes, and compare with patients without diabetes. Methods: 5350 patients with multivessel disease (coronary stenoses ≥70% in ≥2 major epicardial arteries) who underwent PCI between January 1997 and June 2011 were included. Patients were divided into 4 groups according to diabetes and CR status (absence of residual coronary stenosis in major, predominantly proximal, epicardial segments according to Coronary Artery Surgery Study (CASS) classification). Results: Patients with diabetes and patients with incomplete revascularisation (IR) had more adverse clinical and angiographic characteristics. IR was frequent in patients with diabetes, and was marginally more common than in patients without diabetes (47% vs 44%, p<0.001). Patients with diabetes and patients without diabetes had higher mortality rates after IR than after CR (HR 1.56 (95% CI (1.39 to 1.85), p<0.001 for patients with diabetes and 1.70 (95% CI (1.50 to 1.92), p<0.001) in patients without diabetes). However, the absolute risk was higher for patients with diabetes (5-year mortality: IR 35.8%, CR 21.2%) than in patients without diabetes (5-year mortality: IR 22.2%, CR 14.1%). In a multivariable model, IR and diabetes mellitus were independent predictors of total mortality. This effect was present in the bare metal stent and drug-eluting stent eras and in patients with stable disease and acute coronary syndromes. Conclusions: CR is associated with lower long-term mortality in patients with diabetes and patients without diabetes. However the difference was significantly greater in patients with diabetes compared with patients without diabetes.
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Evidence suggests that more complete revascularization in bypassed territories explains the gradual increase in CABG benefit after 4 to 5 years, while incomplete PCI carries a corresponding hazard over that period.
“suggest that the more complete revascularization that can be achieved in bypassed territories accounts for a gradual accrual of benefit beyond 4 to 5 years after CABG, whereas there is an accompanying hazard associated with incomplete PCI over this time course.275,276”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [276]
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Strategies for Multivessel Revascularization in Patients with Diabetes
Farkouh, M. E., Domanski, M., Sleeper, L. A., Siami, F. S., Dangas, G., Mack, M., Yang, M., Cohen, D. J., Rosenberg, Y., Solomon, S. D., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1211585 · Cited by 1,922 · see citing works
Writing Group Members, Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, W. B., Bravata, D. M., Dai, S., Ford, E. S., et al. (2012) · Circulation · doi:10.1161/cir.0b013e3182456d46 · Cited by 1,512 · see citing works
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Arnold, S. V., Bhatt, D. L., Barsness, G. W., Beatty, A. L., Deedwania, P. C., Inzucchi, S. E., Kosiborod, M., Leiter, L. A., Lipska, K. J., Newman, J. D., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000766 · Cited by 304 · see citing works
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- Authors
- Jiménez-Navarro, M. F., López-Jiménez, F., Barsness, G., Lennon, R. J., Sandhu, G. S., & Prasad, A.
- Affiliations
- Hospital Clínico Universitario Virgen de la Victoria (ES)
- Mayo Clinic (US)
- St George's, University of London (GB)
- Corresponding author
- Prasad, Abhiram
- ORCID
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2015-04-16
- Volume
- 101
- Issue
- 15
- Pages
- 1233-1239
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W2169224069
- Cited by
- 21
- References
- 2
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 2
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministerio de Economía y Competitividad
- Instituto de Salud Carlos III
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- complete revascularization, diabetes mellitus, multivessel coronary artery disease, percutaneous coronary intervention, long-term mortality, residual coronary stenosis, bare-metal stents, drug-eluting stents, acute coronary syndrome, stable coronary artery disease
- MeSH terms
- Aged, Aged, 80 and over, Coronary Artery Disease, Diabetic Angiopathies, Female, Humans, Male, Middle Aged, Minnesota, Predictive Value of Tests, Registries, Retrospective Studies, Risk Factors, Time Factors, Stents, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Treatment Outcome, Coronary Angiography, Coronary Stenosis, Kaplan-Meier Estimate, Acute Coronary Syndrome, Angina, Stable, Percutaneous Coronary Intervention
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