Top

Published in:

01-01-2013 | Diabetes and Cardiovascular Disease (S Malik, Section Editor)

Percutaneous Versus Surgical Interventions for Coronary Artery Disease in Those with Diabetes Mellitus

Author: Ozlem Soran

Published in: Current Cardiology Reports | Issue 1/2013

Abstract

Diabetes mellitus (DM) is a metabolic disorder of multiple etiologies that causes long-term damage of various organs including the cardiovascular system. A consistent observation shows that DM amplifies the risk of cardiovascular events by 4- to 6-fold. Since coronary artery disease (CAD) in diabetic patients exhibits diffuse and accelerated lesions, invasive revascularization continues to be a challenge and has worse outcomes than patients without DM. Owing to the pathogenesis of DM and the presence of severe endothelial dysfunction, investigators have been trying to find new treatment modalities that could target the treatment of the disease rather than the treatment of the lesion. Until new treatment modalities are proven and gain acceptance, invasive revascularization remains to be the choice of treatment in such patients. The focus of this review is to compare the results of percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) for the treatment of stable CAD in patients with DM.

Cook S, Windecker S. Surgical vs percutaneous revascularization of coronary artery disease in diabetic patients. Best Pract Res Clin Endocrinol Metab. 2009;23:317–34.PubMedCrossRef

Creager M, Luscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation. 2003;108:1527–32.PubMedCrossRef

Biondi-Zoccai GG, Abbate A, Liuzzo G, Biasucci LM. Atherothrombosis, inflammation and diabetes. J Am Coll Cardiol. 2003;41:1071–7.PubMedCrossRef

Ferreiro JL, Angiolillo DJ. Diabetes and antiplatelet therapy in acute coronary syndrome. Circulation. 2011;123:798–813.PubMedCrossRef

Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14 Suppl 5:S1–85.PubMed

King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.PubMedCrossRef

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.PubMedCrossRef

American Diabetes Association. National Diabetes Fact Sheet, Diabetes Statistics. Available at: http://www.diabetes.org/diabetes-basics/diabetes-statistics.

American Diabetes association. Consensus statement: role of cardiovascular risk factors in prevention and treatment of macrovascular disease in diabetes. Diabetes Care. 1993;16:72–8.

10.

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.PubMedCrossRef

11.

Schramm TK, Gislason GH, Kober L, et al. Diabetes patients requiring glucose-lowering therapy and non-diabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people. Circulation. 2008;117:1945–54.PubMedCrossRef

12.

•• Soran O. (2011). The role of enhanced external counterpulsation therapy in the management of coronary artery disease, angina pectoris. , ed. ISBN: 978–953–307–359–0, InTech, Available at: http://www.intechopen.com/books/angina-pectoris/the-role-of-enhanced-external-counterpulsation-therapy-in-the-management-of-coronary-artery-disease. This book chapter reviews the role of EECP Therapy in CAD and it`s mechanism of action which is different than invasive revascularization. The author underlined the need to initiate a randomized clinical trial to ascertain the efficacy of EECP therapy combined with drug therapy as a first line treatment before any invasive revascularization in selected group of patients with CAD.

13.

Manchanda A, Soran O. Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure. J Am Coll Cardiol. 2007;50:1523–31.PubMedCrossRef

14.

•• Soran O, Manchanda A, Schueler S. Percutaneous coronary intervention vs coronary artery bypass surgery in multivessel disease: a current perspective. Interactive CardioVasc Thorac Surg. 2009;8:666–72. This review article provides an evidence-based perspective on PCI vs CABG in multivessel disease. Since the clinical outcomes differ according to the treatment choice, authors suggest to replace ‘multivessel disease’ terminology with the number of diseased vessel; such as 2VD or 3VD.CrossRef

15.

Lincoff AM. Important triad in cardiovascular medicine: diabetes, coronary intervention, and platelet glycoprotein IIbyIIIa receptor blockade. Circulation. 2003;107:1556–9.PubMedCrossRef

16.

Taggart DP. Coronary artery bypasses graft vs percutaneous coronary angioplasty: CABG on the rebound? Curr Opinion Cardiol. 2007;22:517–23.CrossRef

17.

Brener SJ, Lytle BW, Casserly IP, et al. Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features. Circulation. 2004;109:2290–5.PubMedCrossRef

18.

Niles NW, McGrath PD, Malenka D, et al. Northern New England Cardiovascular Disease Study Group. Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study. J Am Coll Cardiol. 2001;37:1008–15.PubMedCrossRef

19.

Pell JP, Pell AC, Jeffrey RR, et al. Comparison of survival following coronary artery bypass grafting vs percutaneous coronary intervention in diabetic and nondiabetic patients: retrospective cohort study of 6320 procedures. Diabet Med. 2004;21:790–2.PubMedCrossRef

20.

Bair TL, Muhlestein JB, May HT, et al. Surgical revascularization is associated with improved long-term outcomes compared with percutaneous stenting in most subgroups of patients with multivessel coronary artery disease: results from the Intermountain Heart Registry. Circulation. 2007;116(11 Suppl):I226–31.PubMed

21.

Van Domburg RT, Takkenberg JJ, Noordzij LJ, et al. Late outcome after stenting or coronary artery bypass surgery for the treatment of multivessel disease: a single center matched-propensity controlled cohort study. Ann Thorac Surg. 2005;79:1563–9.PubMedCrossRef

22.

Booth J, Clayton T, Pepper J, et al. randomized controlled trial of coronary artery bypass surgery vs percutaneous coronary intervention in patients with multivessel coronary artery disease. Six-year follow-up from the stent or surgery trial (SoS). Circulation. 2008;118:381–8.PubMedCrossRef

23.

Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med. 1996;335:217–25.CrossRef

24.

Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graftsurgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994;344:563–70.PubMedCrossRef

25.

Hoffman SN, TenBrook JA, Wolf MP, et al. A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: 1- to 8-year outcomes. J Am Coll Cardiol. 2003;41:1293–304.PubMedCrossRef

26.

Mercado N, Wijns W, Serruys PW, et al. One-year outcomes of coronary artery bypass graft surgery vs percutaneous coronary intervention with multiple stenting for multisystem disease: a meta-analysis of individual patient data from randomized clinical trials. J Thorac Cardiovasc Surg. 2005;130:512–9.PubMedCrossRef

27.

Serruys PW, Ong AT, van Herwerden LA, et al. Five-year outcomes after coronary stenting vs bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J Am Coll Cardiol. 2005;46:575–81.PubMedCrossRef

28.

Rodriguez A, Boullon F, Perez-Balino N, et al. Argentine randomized trial of percutaneous transluminal coronary angioplasty vs coronary artery surgery in multivessel disease (ERACI): in-hospital results and 1-year follow-up. J Am Coll Cardiol. 1993;22:1060–7.PubMedCrossRef

29.

CABRI Trial Participants. First year results of CABRI (Coronary Angioplasty Versus Bypass Revascularisation Investigation). Lancet. 1995;346:1179–84.CrossRef

30.

King III SB, Lembo NJ, Wientraub WS, et al. A randomized trial comparing coronary angioplasty with coronary bypass surgery: emory angioplasty vs surgery trial (EAST). N Engl J Med. 1994;331:1044–50.PubMedCrossRef

31.

Rodriguez AE, Baldi J, Pereira CF. ERACI II Investigators. Five-year follow-up of the argentine randomized trial of coronary angioplasty with stenting vs coronary bypass surgery in patients with multiple vessel disease (ERACI II). J Am Coll Cardiol. 2005;46:582–8.PubMedCrossRef

32.

Brooks MM, Jones RH, Bach RG, et al. Predictors of mortality and mortality from cardiac causes in the bypass angioplasty revascularization investigation (BARI) randomized trial and registry. For the BARI Investigators. Circulation. 2000;101:2682–9.PubMedCrossRef

33.

Hamm CW, Reimers J, Ischinger T, et al. A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease. German Angioplasty Bypass Surgery Investigation (GABI). N Engl J Med. 1994;331:1037–43.PubMedCrossRef

34.

•• Daemen J, Boersma E, Flather M, et al. Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis with 5-year patient-level data from the ARTS, ERACIII, MASS-II, and SoS trials. Circulation. 2008;118:1146–54. This is a randomized, controlled trial comparing PCI with CABG for patients with multivessel disease. Initial results at a median follow-up of 2 years showed a survival advantage for patients randomized to CABG. At a median follow-up of 6 years, a continuing survival advantage was observed for patients managed with CABG.PubMedCrossRef

35.

Goy JJ, Kaufmann U, Hurni M. SIMA Investigators. 10-year follow-up of a prospective randomized trial comparing bare-metal stenting with internal mammary artery grafting for proximal, isolated de novo left anterior coronary artery stenosis the SIMA (Stenting vs Internal Mammary Artery grafting) trial. J Am Coll Cardiol. 2008;52:815–7.PubMedCrossRef

36.

Goy JJ, Eeckhout E, Moret C, et al. Five-year outcome in patients with isolated proximal left anterior descending coronary artery stenosis treated by angioplasty or left internal mammary artery grafting. A prospective trial. Circulation. 1999;99:3255–9.PubMedCrossRef

37.

Carrié D, Elbaz M, Puel J, et al. Five-year outcome after coronary angioplasty vs bypass surgery in multivessel coronary artery disease: results from the French Monocentric Study. Circulation. 1997;96((Suppl):II):1–6.

38.

Morrison DA, Sethi G, Sacks J, et al. Angina With Extremely Serious Operative Mortality Evaluation (AWESOME). Percutaneous coronary intervention vs coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial. Investigators of the Department of Veterans Affairs Cooperative Study 385, the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME). J Am Coll Cardiol. 2002;39:555–6.CrossRef

39.

Hueb W, Lopes NH, Gersh BJ, et al. Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation. 2007;115:1082–9.PubMedCrossRef

40.

•• Banning AP, Westaby S, Morice MC, 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;55:1067–75. Results of this trial showed that PCI with TAXUS (paclitaxel-eluting) stenting was inferior to CABG with respect to the primary composite of death, stroke, myocardial infarction, or repeat revascularization among patients with left main and or 3 vessel disease. The pre-specified DM-subgroup analysis showed that, driven by an increased rate of repeat revascularization, the 1-year death, stroke, myocardial infarction, or repeat revascularization rate was significantly higher among DM patients treated with DES than with CABG.PubMedCrossRef

41.

.•• Kapur A, Hall RJ, Malik I, et al. 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;55:432–40. At 1 year, the primary endpoint of death, myocardial infarction, and stroke did not differ among the groups while the need of repeat revascularization was significantly higher in the PCI group.PubMedCrossRef

42.

Al-Ruzzeh S, George S, Bustami M, et al. Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomized controlled trial. BMJ. 2006;332:1365.PubMedCrossRef

43.

Hannan EL, Wu C, Smith CR, et al. Off-pump vs on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation. 2007;116:1145–52.PubMedCrossRef

44.

Kim WS, Lee J, Lee YT, et al. Total arterial revascularization in triple-vessel disease with off-pump and aortic no-touch technique. Ann Thorac Surg. 2008;86:1861–5.PubMedCrossRef

45.

Navia D, Vrancic M, Vaccarino G, et al. Total arterial off-pump coronary revascularization using bilateral internal thoracic arteries in triple-vessel disease: surgical technique and clinical outcomes. Ann Thorac Surg. 2008;86:524–30.PubMedCrossRef

46.

Yan Q, Changsheng M, Shaoping N, et al. Percutaneous treatment with drug-eluting stent vs bypass surgery in patients suffering from chronic stable angina with multivessel disease involving significant proximal stenosis in left anterior descending artery. Circ J. 2009;73:1848–55.PubMedCrossRef

47.

Cheng CI, Lee FY, Chang JP, et al. Long-term outcomes of intervention for unprotected left main coronary artery stenosis: coronary stenting vs coronary artery bypass grafting. Circ J. 2009;73:705–12.PubMedCrossRef

48.

•• Briguori C, Condorelli G, Airoldi F, et al. Comparison of coronary drug-eluting stents vs coronary artery bypass grafting in patients with diabetes mellitus. Am J Cardiol. 2007;99:779–84. Results showed the superiority of OPCAB at 1-year follow-up compared with DES.PubMedCrossRef

49.

•• Yamagata K, Kataoka Y, Kokubu N, et al. A 3-year clinical outcomes after percutaneous coronary intervention using sirolimus–eluting stent and off-pump coronary artery bypass grafting for the treatment of diabetic patients with multivessel disease. Circ J. 2010;74:671–8. Diabetic patients with multivessel disease were examined (DES vs OPCAB). During the follow-up period (mean: 42 ± 8 months), the cumulative MACCE was similar between the 2 groups. However, the rate of revascularization was significantly higher in the DES group than the OPCAB group.PubMedCrossRef

50.

Weintraub WS, Grau-Sepulveda MV, Weiss JM, et al. Comparative effectiveness of revascularization strategies. N Engl J Med. 2012;19(366):1467–76.CrossRef

51.

Yang T-H, Park S-W, Hong M-K, et al. Impact of diabetes mellitus on angiographic and clinical outcomes in the drug-eluting stents era. Am J Cardiol. 2005;96:1389–92.PubMedCrossRef

52.

•• Voudris V, Karyofillis P, Thomopoulou S, et al. Long-term results after drug-eluting stent implantation in diabetic patients according to diabetic treatment. Hellenic J Cardiol. 2011;52:15–22. This study assessed the long-term results after DES implantation in non insulin-dependent diabetic patients compared with insulin-dependent patients. At 12-month follow-up no significant differences in the incidence of death or non-fatal myocardial infarction were observed, but target lesion revascularization and bypass surgery were more frequent in the insulin-dependent group.PubMed

53.

Sabaté M, Jiménez-Quevedo P, Angiolillo DJ, et al. Randomized comparison of sirolimus-eluting stent vs standard stent for percutaneous coronary revascularization in diabetic patients: the diabetes and sirolimus-eluting stent (DIABETES) trial. Circulation. 2005;112:2175–83.PubMedCrossRef

54.

Boyden TF, Nallamothu BK, Moscucci M, et al. Meta-analysis of randomized trials of drug-eluting stents vs bare metal stents in patients with diabetes mellitus. Am J Cardiol. 2007;99:1399–402.PubMedCrossRef

55.

Scheen AJ, Warzée F, Legrand VMG. Drug-eluting stents: meta-analysis in diabetic patients. Eur Heart J. 2004;25:2167–8.PubMedCrossRef

56.

Morgan KP, Kapur A, Beatt KJ. Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention. Heart. 2004;90:732–8.PubMedCrossRef

57.

Sowers JR, Epstein M. Diabetes mellitus and associated hypertension, vascular disease, and nephropathy. An update. Hypertension. 1995;26(6 Pt 1):869–79.PubMedCrossRef

58.

Tesfamariam B. Free radicals in diabetic endothelial cell dysfunction. Free Radic Biol Med. 1994;16:383–91.PubMedCrossRef

59.

Umeda F, Inoguchi T, Nawata H, Umeda F, Inoguchi T, Nawata H. Reduced stimulatory activity on prostacyclin production by cultured endothelial cells in serum from aged and diabetic patients. Atherosclerosis. 1989;75:61–6.PubMedCrossRef

60.

Betteridge DJ. Diabetic dyslipidemia. Am J Med. 1994;96:25S–31S.PubMedCrossRef

61.

Creager MA, Cooke JP, Mendelsohn ME, et al. Impaired vasodilation of forearm resistance vessels in hypercholesterolemic humans. J Clin Invest. 1990;86:228–34.PubMedCrossRef

62.

Aronson D, Bloomgarden Z, Rayfield EJ. Potential mechanisms promoting restenosis in diabetic patients. J Am Coll Cardiol. 1996;27:528–35.PubMedCrossRef

63.

Kornowski R, Mintz GS, Kent KM, et al. Increased restenosis in diabetes mellitus after coronary interventions is due to exaggerated intimal hyperplasia. A serial intravascular ultra sound study. Circulation. 1997;95:1366–9.PubMedCrossRef

64.

Lemos PA, Serruys PW, van Domburg RT, et al. Unrestricted utilization of sirolimus-eluting stents compared with conventional bare stent implantation in the “real world”: the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. Circulation. 2004;109:190–5.PubMedCrossRef

65.

Dardas PS, Tsikaderis DD, Mezilis NE, Hatzimiltiadis S. Medium-term results from the clinical and angiographic follow-up of patients after angioplasty and implantation of sirolimus- drug eluting stents. Hellenic J Cardiol. 2005;46:117–23.PubMed

66.

•• Ortolani P, Balducelli M, Marzaroli P, et al. Two-year clinical outcomes with drug-eluting stents for diabetic patients with de novo coronary lesions: results from a real-world multicenter registry. Circulation. 2008;117:923–30. This was a real-world multicenter registry, no benefit was demonstrated among insulin-dependent diabetic patients after DES implantation, whereas non- insulin-dependent diabetic patients showed substantial improvements in the 2-year relative risk of major adverse cardiac events and target vessel revascularization.PubMedCrossRef

67.

Moussa I, Leon MB, Baim DS, et al. Impact of sirolimus-eluting stents on outcome in diabetic patients: a SIRIUS (SIRolImUS- coated Bx Velocity balloon-expandable a SIRIUS (SIRolImUS- coated Bx Velocity balloon-expandable Stent in the treatment of patients with de novo coronary artery lesions) substudy. Circulation. 2004;109:2273–8.PubMedCrossRef

68.

Machecourt J, Danchin N, Lablanche JM, et al. Risk factors for diabetic and nondiabetic patients: the EVASTENT Matched-Cohort Registry. J Am Coll Cardiol. 2007;50:501–8.PubMedCrossRef

69.

Natali A, Vichi S, Landi P, et al. Coronary atherosclerosis in type II diabetes: angiographic findings and clinical outcome. Diabetologia. 2000;43:632–41.PubMedCrossRef

70.

Iijima R, Ndrepepa G, Mehilli J, et al. Impact of diabetes mellitus on long-term outcomes in the drug-eluting stent era. Am Heart J. 2007;154:688–93.PubMedCrossRef

71.

• Kirtane AJ, Ellis SG, Dawkins KD, et al. Paclitaxel-eluting coronary stents in patients with diabetes mellitus: pooled analysis from 5 randomized trials. J Am Coll Cardiol. 2008;51:708–15. This is a pooled analysis of 5 randomized trials, where rates of all-cause mortality, cardiac and noncardiac death were similar for DES and BMS in insulin-dependent diabetic patients and noninsulin-dependent diabetic patients.PubMedCrossRef

72.

Park D-W, Flaherty JD, Davidson CJ, et al. Prognostic influence of diabetes mellitus on long-term clinical outcomes and stent thrombosis after drug-eluting stent implantation in asian patients. Am J Cardiol. 2009;103:646–52.PubMedCrossRef

73.

• Legrand VM, Garg S, Serruys PW, et al. Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs coronary artery bypass surgery and bare metal stent, insight from the multicentre randomized Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II). EuroIntervention. 2011;6:838–45. Results of this study showed that diabetes was the strongest independent predictor of MACCE among PCI treated patients but didn't affect 3-year outcomes following CABG.PubMedCrossRef

74.

Hill R, Bagust A, Bakhai A, et al. Coronary artery stent. A rapid systematic review and economic evaluation. Health Technol Assess. 2004;8:1242–5.

75.

Griffin SC, Barber JA, Manca A, et al. Cost effectiveness of clinically appropriate decisions on alternative treatments for angina pectoris: prospective observational study. BMJ. 2007;334:624–7.PubMedCrossRef

76.

Soran O, Feldman AM, Cohen HA. Oculostenotic reflex and iatrogenesis fulminans. Circulation. 2000;101:E198.PubMedCrossRef

Title: Percutaneous Versus Surgical Interventions for Coronary Artery Disease in Those with Diabetes Mellitus
Author: Ozlem Soran
Publication date: 01-01-2013
Publisher: Current Science Inc.
Published in: Current Cardiology Reports / Issue 1/2013
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-012-0323-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Percutaneous Versus Surgical Interventions for Coronary Artery Disease in Those with Diabetes Mellitus

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2013

Modeling of Fractional Flow Reserve Based on Coronary CT Angiography

The Prognostic Value of Late Gadolinium Enhancement CMR in Nonischemic Cardiomyopathies

Cardiovascular Effects of Anti-Diabetic Medications in Type 2 Diabetes Mellitus

Coronary Calcium: New Insights, Recent Data, and Clinical Role

Transcatheter Aortic Valve Repair, Imaging, and Electronic Imaging Health Record

Imaging of Inflammation and Calcification in Aortic Stenosis