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Unprotected left main coronary artery disease after revascularization

Effect of diabetes on patient outcomes

Koronare Herzkrankheit des ungeschützten linken Hauptstamms nach Revaskularisierung

Einfluss von Diabetes mellitus auf das Ergebnis für den Patienten

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Abstract

Objective

It is unknown whether the effect of diabetes on patients with unprotected left main coronary artery (LMCA) disease differs according to the different revascularization strategies. This study was conducted to evaluate the impact of diabetes on patients with unprotected LMCA disease treated with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Patients and methods

We prospectively enrolled 823 consecutive patients with unprotected LMCA disease who had drug-eluting stent (DES; n = 331) implantation or underwent CABG (n = 492) in the study. We compared the effects of diabetes on clinical outcomes according to different revascularization strategies.

Results

Among 823 eligible patients enrolled, 226 had diabetes. In the DES population, no significant differences were observed in occurrences of death, cardiac death, repeat revascularization, stroke, and major adverse cardiac and cerebrovascular events. However, the risks of the composite of death/myocardial infarction (MI)/stroke (21.5 % DM vs. 7.2 % non-DM; p = 0.001) and MI (15.4 % DM vs. 1.6 % non-DM; p = 0.000) were significantly higher in the diabetic patients than those without diabetes. In the CABG population, similar rates of all clinical endpoints were observed between the diabetic and nondiabetic group.

Conclusion

Diabetes was associated with worse outcome in patients undergoing DES implantation for the treatment of unprotected LMCA disease. However, its negative prognostic impact was not found among patients undergoing CABG.

Zusammenfassung

Ziel

Ob sich die Auswirkungen eines Diabetes mellitus auf Patienten mit koronarer Herzkrankheit (KHK) des ungeschützten Hauptstamms (LMCA) bei verschiedenen Revaskularisierungsstrategien unterscheiden, ist nicht bekannt. Die vorliegende Studie wurde durchgeführt, um den Einfluss eines Diabetes auf Patienten mit KHK des ungeschützten LMCA zu untersuchen, die entweder mittels perkutaner Koronarintervention (PCI) oder mit einem Koronarbypass (CABG) behandelt wurden.

Methoden

An der Studie nahmen 823 konsekutive Patienten mit KHK des ungeschützten LMCA teil, bei denen die Versorgung mit der Implantation von medikamentenfreisetzenden Stents (DES, n = 331) oder einem CABG (n = 492) erfolgte. Es wurden die Auswirkungen eines Diabetes auf klinische Ergebnisse in Abhängigkeit von den verschiedenen Revaskularisierungsstrategien verglichen.

Ergebnisse

Von 823 für die Studie geeigneten Patienten wiesen 226 einen Diabetes mellitus (DM) auf. In der DES-Gruppe wurden keine signifikanten Unterschiede hinsichtlich des Auftretens von Todesfällen, Herztod, wiederholter Revaskularisierung, Schlaganfall und schweren unerwünschten kardialen und zerebrovaskulären Ereignissen (MACCE) beobachtet. Allerdings war das Risiko für den zusammengesetzten Endpunkt aus Tod/Herzinfarkt/Schlaganfall (21,5 % DM vs. 7,2 % ohne DM; p = 0,001) und Herzinfarkt (15,4 % DM vs. 1,6 % ohne DM; p = 0,000) bei Patienten mit Diabetes signifikant höher als bei Patienten ohne. In der CABG-Gruppe wurden ähnliche Raten aller klinischen Endpunkte für die Gruppen mit und ohne Diabetes beobachtet.

Schlussfolgerung

Ein Diabetes mellitus stand mit einem schlechteren Ergebnis bei Patienten mit DES-Implantation zur Therapie einer KHK des ungeschützten LMCA in Zusammenhang. Jedoch war der negative prognostische Einfluss des Diabetes nicht bei Patienten mit CABG festzustellen.

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Compliance with ethical guidelines

Conflict of interest. X. Yu, Y. Luo, J. He, Y. Gao, Y. Zhang, X. Zhang, C. Wu, X. Ren, S. Lv and F. Chen state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, 2 Anzhen Road, 100029, Beijing, China

    X. Yu, Y. Luo, J. He, Y. Gao, Y. Zhang, X. Zhang, C. Wu, X. Ren,  S. Lv &  F. Chen

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  1. X. Yu
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  2. Y. Luo
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  3. J. He
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  4. Y. Gao
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  7. C. Wu
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Correspondence to S. Lv or F. Chen.

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Yu, X., Luo, Y., He, J. et al. Unprotected left main coronary artery disease after revascularization. Herz 40, 116–122 (2015). https://doi.org/10.1007/s00059-013-3959-z

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  • DOI: https://doi.org/10.1007/s00059-013-3959-z

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