CABG Versus PCI in the Treatment of Unprotected Left Main Disease in Diabetics: A Literature Review

Overview

Journal Int J Angiol

Date 2021 Nov 15

PMID 34776818

Citations 1

Authors

Daniel Lambert

Allan Mattia

Angel Hsu

Frank Manetta

Affiliations

Soon will be listed here.

Abstract

The approach to left main coronary artery disease (CAD) in diabetic patients has been extensively debated. Diabetic patients have an elevated risk of left main disease in addition to multivessel disease. Previous trials have shown increased revascularization rates in percutaneous coronary intervention compared with coronary artery bypass grafting (CABG) but overall comparable outcomes, although many of these studies were not using the latest stent technology or CABG with arterial revascularization. Our aim is to review the most recent trials that have recently published long-term follow-up, as well as other literature pertaining to left main disease in diabetic patients. Furthermore, we will be discussing some future treatment strategies that could likely create a paradigm shift in how left main CAD is managed.

Citing Articles

Diabetes Mellitus in Acute Coronary Syndrome.

Stampouloglou P, Anastasiou A, Bletsa E, Lygkoni S, Chouzouri F, Xenou M Life (Basel). 2023; 13(11).

PMID: 38004366 PMC: 10671950. DOI: 10.3390/life13112226.

References

Kassimis G, Bourantas C, Tushar R, De Maria G, Davlouros P, Hahalis G . Percutaneous coronary intervention vs. cardiac surgery in diabetic patients. Where are we now and where should we be going?. Hellenic J Cardiol. 2017; 58(3):178-189. DOI: 10.1016/j.hjc.2017.01.028. View

Hoole S, Bambrough P . Recent advances in percutaneous coronary intervention. Heart. 2020; 106(18):1380-1386. DOI: 10.1136/heartjnl-2019-315707. View

Kapur A, Hall R, Malik I, Qureshi A, Butts J, de Belder M . Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. J Am Coll Cardiol. 2010; 55(5):432-40. DOI: 10.1016/j.jacc.2009.10.014. View

Habibi S, Shah R, Berzingi C, Melchior R, Sumption K, Jovin I . Left main coronary artery stenosis: severity evaluation and implications for management. Expert Rev Cardiovasc Ther. 2017; 15(3):157-163. DOI: 10.1080/14779072.2017.1294065. View

Raja S, Garg S, Rochon M, Daley S, De Robertis F, Bahrami T . Short-term clinical outcomes and long-term survival of minimally invasive direct coronary artery bypass grafting. Ann Cardiothorac Surg. 2018; 7(5):621-627. PMC: 6219940. DOI: 10.21037/acs.2018.06.14. View

Park D, Ahn J, Park H, Yun S, Kang D, Lee P . Ten-Year Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease: Extended Follow-Up of the PRECOMBAT Trial. Circulation. 2020; 141(18):1437-1446. DOI: 10.1161/CIRCULATIONAHA.120.046039. View

Gaudino M, Angiolillo D, Di Franco A, Capodanno D, Bakaeen F, Farkouh M . Stroke After Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention: Incidence, Pathogenesis, and Outcomes. J Am Heart Assoc. 2019; 8(13):e013032. PMC: 6662343. DOI: 10.1161/JAHA.119.013032. View

Lehto H, Pietila A, Niiranen T, Lommi J, Salomaa V . Clinical practice patterns in revascularization of diabetic patients with coronary heart disease: nationwide register study. Ann Med. 2020; 52(5):225-232. PMC: 7877943. DOI: 10.1080/07853890.2020.1771757. View

Stone G, Sabik J, Serruys P, Simonton C, Genereux P, Puskas J . Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med. 2016; 375(23):2223-2235. DOI: 10.1056/NEJMoa1610227. View

10.

Verma S, Farkouh M, Yanagawa B, Fitchett D, Ahsan M, Ruel M . Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol. 2014; 1(4):317-28. DOI: 10.1016/S2213-8587(13)70089-5. View

11.

Dai X, Luo Z, Zhai L, Zhao W, Huang F . Reassessing Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients with Type 2 Diabetes Mellitus: A Brief Updated Analytical Report (2015-2017). Diabetes Ther. 2018; 9(5):2163-2171. PMC: 6167293. DOI: 10.1007/s13300-018-0504-3. View

12.

Wiemer M, Stoikovic S, Samol A, Dimitriadis Z, Ruiz-Nodar J, Birkemeyer R . Third generation drug eluting stent (DES) with biodegradable polymer in diabetic patients: 5 years follow-up. Cardiovasc Diabetol. 2017; 16(1):23. PMC: 5301341. DOI: 10.1186/s12933-017-0500-3. View

13.

Zhai C, Cong H, Hou K, Hu Y, Zhang J, Zhang Y . Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies. Diabetol Metab Syndr. 2020; 11:110. PMC: 6923849. DOI: 10.1186/s13098-019-0506-y. View

14.

Farkouh M, Domanski M, Sleeper L, Siami F, Dangas G, Mack M . Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012; 367(25):2375-84. DOI: 10.1056/NEJMoa1211585. View

15.

Flaherty J, Davidson C . Diabetes and coronary revascularization. JAMA. 2005; 293(12):1501-8. DOI: 10.1001/jama.293.12.1501. View

16.

Singh M, Arora R, Kodumuri V, Khosla S, Jawad E . Coronary revascularization in diabetic patients: Current state of evidence. Exp Clin Cardiol. 2011; 16(1):16-22. PMC: 3076161. View

17.

Stefanini G, Byrne R, Serruys P, de Waha A, Meier B, Massberg S . Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: a pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS.... Eur Heart J. 2012; 33(10):1214-22. DOI: 10.1093/eurheartj/ehs086. View

18.

Xin X, Wang X, Dong X, Fan Y, Shao W, Lu X . Efficacy and safety of drug-eluting stenting compared with bypass grafting in diabetic patients with multivessel and/or left main coronary artery disease. Sci Rep. 2019; 9(1):7268. PMC: 6513866. DOI: 10.1038/s41598-019-43681-x. View

19.

Mack M, Banning A, Serruys P, Morice M, Taeymans Y, Van Nooten G . Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. Ann Thorac Surg. 2011; 92(6):2140-6. DOI: 10.1016/j.athoracsur.2011.06.028. View

20.

Jonsson A, Ivert T, Svane B, Liska J, Jakobsson K, Hammar N . Classification of left main coronary obstruction--feasibility of surgical angioplasty and survival after coronary artery bypass surgery. Cardiovasc Surg. 2003; 11(6):497-505. DOI: 10.1016/S0967-2109(03)00111-X. View