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Lambert D, Mattia A, Hsu A, Manetta F. CABG versus PCI in the Treatment of Unprotected Left Main Disease in Diabetics: A Literature Review. Int J Angiol 2021; 30:187-193. [PMID: 34776818 DOI: 10.1055/s-0041-1735517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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.
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Affiliation(s)
- Daniel Lambert
- Department of Cardiac Surgery, North Shore-Long Island Jewish Medical Center, Manhasset, New York
| | - Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York.,Hofstra Northwell School of Medicine, Department of Surgery, Hempstead, New York
| | - Angel Hsu
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Frank Manetta
- Department of Cardiothoracic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
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Sharma K, Dani S, Desai D, Kumar P, Bhalani N, Vasavada A, Trivedi R. Two-year safety and efficacy of Indigenous Abluminus Sirolimus Eluting Stent. Does it differ amongst diabetics? - Data from en-ABLe- REGISTRY. J Cardiovasc Thorac Res 2021; 13:162-168. [PMID: 34326971 PMCID: PMC8302901 DOI: 10.34172/jcvtr.2021.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics. Methods: In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vessel related myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST). Results: Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/TVR - 1.4% at both the intervals for 2493 patients at 2 yrs. follow-up. TV-MI & ST were 0.36% and0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3%vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0vs 2.1% at 2 years) was significant (P < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST (P > 0.05). Conclusion: Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST.
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Affiliation(s)
- Kamal Sharma
- Department of Cardiology, UNMICRC, BJ Medical College, Ahmedabad (Gujarat), India
| | - Sameer Dani
- Apollo Hospitals Ahmedabad and Limsar, Ahmedabad (Gujarat), India
| | - Devang Desai
- Unicare Hospital, Mahavir Hospital, Surat (Gujarat) India
| | - Prathap Kumar
- ESIC Hospital Kollam and Meditrina Hospital, Kerala, India
| | - Nirav Bhalani
- Rhythm Hopsital and Sunshine Global, Vadodara (Gujarat), India
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4
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Lee K, Ahn JM, Yoon YH, Kang DY, Park SY, Ko E, Park H, Cho SC, Park S, Kim TO, Lee PH, Lee SW, Park SW, Park DW, Park SJ. Long-Term (10-Year) Outcomes of Stenting or Bypass Surgery for Left Main Coronary Artery Disease in Patients With and Without Diabetes Mellitus. J Am Heart Assoc 2020; 9:e015372. [PMID: 32310027 PMCID: PMC7428513 DOI: 10.1161/jaha.119.015372] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Data are still limited regarding whether there are differential long-term outcomes after percutaneous coronary intervention versus coronary artery bypass grafting (CABG) for left main coronary artery disease with or without diabetes mellitus (DM). Methods and Results Using the 10-year data from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry, we sought to examine the effect of DM on comparative outcomes after percutaneous coronary intervention or CABG in patients with unprotected left main coronary artery disease. The outcomes of interest were all-cause mortality; a composite of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization. The primary adjusted analyses were performed with the use of propensity scores and inverse-probability weighting. Of 2240 patients with left main coronary artery revascularization, 722 (32%) had DM. In the overall population, the adjusted 10-year risks of death and composite outcome were similar between percutaneous coronary intervention and CABG, irrespective of DM status (Pinteraction: 0.41, mortality; 0.40, composite outcome). However, in the cohort of bare-metal stents and concurrent CABG, we observed differential outcomes after stenting and CABG by DM status (Pinteraction: 0.09, mortality; 0.04, composite outcome), favoring CABG in patients with DM. In the cohort of drug-eluting stents and concurrent CABG, the better effect of CABG over stenting was narrowed in patients with DM without a significant interaction (Pinteraction: 0.63, mortality; 0.47, composite outcome). Conclusions In this cohort of patients with longest follow-up who underwent left main coronary artery revascularization, the clinical impact of DM favoring CABG over percutaneous coronary intervention has diminished over time from the bare-metal stent to the drug-eluting stent era. Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02791412.
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Affiliation(s)
- Kyusup Lee
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jung-Min Ahn
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Yong-Hoon Yoon
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Do-Yoon Kang
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Seo-Young Park
- Department of Clinical Epidemiology and Biostatistics Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Euihong Ko
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Hanbit Park
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Sang-Cheol Cho
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Sangwoo Park
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Tae Oh Kim
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Pil Hyung Lee
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Seung-Whan Lee
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Seong-Wook Park
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Duk-Woo Park
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Seung-Jung Park
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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Santiago-Fernández C, Pérez-Belmonte LM, Millán-Gómez M, Moreno-Santos I, Carrasco-Chinchilla F, Ruiz-Salas A, Morcillo-Hidalgo L, Melero JM, Garrido-Sánchez L, Jiménez-Navarro M. Overexpression of scavenger receptor and infiltration of macrophage in epicardial adipose tissue of patients with ischemic heart disease and diabetes. J Transl Med 2019; 17:95. [PMID: 30894181 PMCID: PMC6425581 DOI: 10.1186/s12967-019-1842-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/11/2019] [Indexed: 12/20/2022] Open
Abstract
Background Oxidized low-density lipoproteins and scavenger receptors (SRs) play an important role in the formation and development of atherosclerotic plaques. However, little is known about their presence in epicardial adipose tissue (EAT). The objective of the study was to evaluate the mRNA expression of different SRs in EAT of patients with ischemic heart disease (IHD), stratifying by diabetes status and its association with clinical and biochemical variables. Methods We analyzed the mRNA expression of SRs (LOX-1, MSR1, CXCL16, CD36 and CL-P1) and macrophage markers (CD68, CD11c and CD206) in EAT from 45 patients with IHD (23 with type 2 diabetes mellitus (T2DM) and 22 without T2DM) and 23 controls without IHD or T2DM. Results LOX-1, CL-P1, CD68 and CD11c mRNA expression were significantly higher in diabetic patients with IHD when compared with those without T2DM and control patients. MSR1, CXCL16, CD36 and CD206 showed no significant differences. In IHD patients, LOX-1 (OR 2.9; 95% CI 1.6–6.7; P = 0.019) and CD68 mRNA expression (OR 1.7; 95% CI 0.98–4.5; P = 0.049) were identified as independent risk factors associated with T2DM. Glucose and glycated hemoglobin were also shown to be risk factors. Conclusions SRs mRNA expression is found in EAT. LOX-1 and CD68 and were higher in IHD patients with T2DM and were identified as a cardiovascular risk factor of T2DM. This study suggests the importance of EAT in coronary atherosclerosis among patients with T2DM.
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Affiliation(s)
- Concepción Santiago-Fernández
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus de Teatinos s/n, 29010, Malaga, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Malaga, Spain
| | - Luis M Pérez-Belmonte
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Campus Universitario de Teatinos, s/n., Malaga, Spain. .,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Malaga, Spain.
| | - Mercedes Millán-Gómez
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Campus Universitario de Teatinos, s/n., Malaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Malaga, Spain
| | - Inmaculada Moreno-Santos
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Campus Universitario de Teatinos, s/n., Malaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Malaga, Spain
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Campus Universitario de Teatinos, s/n., Malaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Malaga, Spain
| | - Amalio Ruiz-Salas
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Campus Universitario de Teatinos, s/n., Malaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Malaga, Spain
| | - Luis Morcillo-Hidalgo
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Campus Universitario de Teatinos, s/n., Malaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Malaga, Spain
| | - José M Melero
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Campus Universitario de Teatinos, s/n., Malaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Malaga, Spain
| | - Lourdes Garrido-Sánchez
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus de Teatinos s/n, 29010, Malaga, Spain. .,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Malaga, Spain.
| | - Manuel Jiménez-Navarro
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Campus Universitario de Teatinos, s/n., Malaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Malaga, Spain
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Abstract
PURPOSE OF REVIEW To provide an update on the management of patients with diabetes mellitus and requiring coronary revascularization. RECENT FINDINGS Evidence continues to show that patients with diabetes mellitus and ischemic heart disease represent a very high-risk group of patients. Choice of stent appears important for minimizing target lesion and target vessel adverse events with everolimus eluting stents having the best performance, particularly in patients being treated with insulin. The higher risk of adverse angioplasty results in patients with diabetes appears most related to the disease state per se and not necessarily to anatomical complexities. Interestingly, physiologic documentation of nonischemia producing lesions with use of fractional flow reserve appears less reassuring in this setting of aggressive and rapid atherosclerosis progression, particularly if myocardial infarction has occurred previously, than in patients without diabetes. Coronary artery bypass surgery in patients with appropriate anatomy and diabetes continues to emerge in many analyzes as the optimal, long-term therapy. IMPLICATIONS The treatment of diabetes per se, advances in stent technology and optimization of coronary artery bypass techniques are all occurring in parallel making it very critical for the design of modern era trials that keep pace with these advances. Currently, in patients with appropriate anatomy who are willing candidates, bypass surgery remains the optimal, long-term therapeutic option.
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