Percutaneous coronary intervention versus coronary artery bypass grafting in patients with diabetic nephropathy and left main coronary artery disease

Hsin Ru Li, Chiao Po Hsu, Shih Hsien Sung, Chun Che Shih, Shing Jong Lin, Wan Leong Chan, Cheng Hsueh Wu, Tse Min Lu

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Patients with diabetic nephropathy and unprotected left main (LM) coronary artery disease suffer from high cardiovascular morbidity and mortality. Although surgical revascularization is currently recommended in this special patient population, the optimal revascularization method for this distinct patient group has remained unclear. Methods:We collected 99 consecutive patients with unprotected LMdisease and diabetic nephropathy, including 46 patients who had undergone percutaneous coronary intervention (PCI), and 53 who had coronary artery bypass grafting (CABG), with amean age of 72 ± 10; with 80.8% male. Diabetic nephropathywas defined as overt proteinuria (proteinuria > 500 mg/day) and estimated glomerular filtration rate (eGFR) by the modified Modification of Diet in Renal Disease (MDRD) equation of less than 60 mL/min/1.73m 2 . The baseline characteristics, angiographic results and long-term clinical outcomes were retrospectively analyzed. Results: The baseline characteristic of all patients were similar except for smokers, low density lipoprotein (LDL) level and extension of coronary artery disease involvement. The median follow-up period was 3.8 years. There were 73 patients (74%) considered as high risk with additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≤ 6. During follow-up period, the long term rate of all-cause death (PCI vs. CABG: 45.7% vs. 58.5%, p = 0.20) and all-cause death/myocardial infarction (MI)/stroke (PCI vs. CABG: 52.2% vs. 60.4%, p = 0.41) were comparable between the PCI and CABG group, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI vs. CABG: 32.6% vs. 9.4%, p < 0.01). eGFR remained an independent predictor for all-cause death [hazard ratio: 0.97, 95% confidence interval: 0.96 to 0.99; p = 0.002] in multivariate logistic regression. Conclusions: In the real-world practice of high-risk patients with unprotected LM disease and diabetic nephropathy, we found that PCI was a comparable alternative to CABG in terms of long-term risks of all-cause death/MI/stroke, with significantly higher repeat revascularization rate. Given the small patient number and retrospective nature, our findings should be validated by larger-scale randomized studies.

Original languageEnglish
Pages (from-to)119-126
Number of pages8
JournalActa Cardiologica Sinica
Volume33
Issue number2
DOIs
Publication statusPublished - Mar 1 2017
Externally publishedYes

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Diabetic Nephropathies
Percutaneous Coronary Intervention
Coronary Artery Bypass
Coronary Artery Disease
Cause of Death
Glomerular Filtration Rate
Proteinuria
Stroke
Myocardial Infarction
Diet Therapy
LDL Lipoproteins
Logistic Models
Confidence Intervals
Morbidity
Kidney
Mortality

Keywords

  • Chronic kidney disease
  • Coronary artery bypass grafting
  • Diabetes mellitus
  • Diabetic nephropathy
  • Left main coronary artery disease
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with diabetic nephropathy and left main coronary artery disease. / Li, Hsin Ru; Hsu, Chiao Po; Sung, Shih Hsien; Shih, Chun Che; Lin, Shing Jong; Chan, Wan Leong; Wu, Cheng Hsueh; Lu, Tse Min.

In: Acta Cardiologica Sinica, Vol. 33, No. 2, 01.03.2017, p. 119-126.

Research output: Contribution to journalArticle

Li, Hsin Ru ; Hsu, Chiao Po ; Sung, Shih Hsien ; Shih, Chun Che ; Lin, Shing Jong ; Chan, Wan Leong ; Wu, Cheng Hsueh ; Lu, Tse Min. / Percutaneous coronary intervention versus coronary artery bypass grafting in patients with diabetic nephropathy and left main coronary artery disease. In: Acta Cardiologica Sinica. 2017 ; Vol. 33, No. 2. pp. 119-126.
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abstract = "Background: Patients with diabetic nephropathy and unprotected left main (LM) coronary artery disease suffer from high cardiovascular morbidity and mortality. Although surgical revascularization is currently recommended in this special patient population, the optimal revascularization method for this distinct patient group has remained unclear. Methods:We collected 99 consecutive patients with unprotected LMdisease and diabetic nephropathy, including 46 patients who had undergone percutaneous coronary intervention (PCI), and 53 who had coronary artery bypass grafting (CABG), with amean age of 72 ± 10; with 80.8{\%} male. Diabetic nephropathywas defined as overt proteinuria (proteinuria > 500 mg/day) and estimated glomerular filtration rate (eGFR) by the modified Modification of Diet in Renal Disease (MDRD) equation of less than 60 mL/min/1.73m 2 . The baseline characteristics, angiographic results and long-term clinical outcomes were retrospectively analyzed. Results: The baseline characteristic of all patients were similar except for smokers, low density lipoprotein (LDL) level and extension of coronary artery disease involvement. The median follow-up period was 3.8 years. There were 73 patients (74{\%}) considered as high risk with additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≤ 6. During follow-up period, the long term rate of all-cause death (PCI vs. CABG: 45.7{\%} vs. 58.5{\%}, p = 0.20) and all-cause death/myocardial infarction (MI)/stroke (PCI vs. CABG: 52.2{\%} vs. 60.4{\%}, p = 0.41) were comparable between the PCI and CABG group, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI vs. CABG: 32.6{\%} vs. 9.4{\%}, p < 0.01). eGFR remained an independent predictor for all-cause death [hazard ratio: 0.97, 95{\%} confidence interval: 0.96 to 0.99; p = 0.002] in multivariate logistic regression. Conclusions: In the real-world practice of high-risk patients with unprotected LM disease and diabetic nephropathy, we found that PCI was a comparable alternative to CABG in terms of long-term risks of all-cause death/MI/stroke, with significantly higher repeat revascularization rate. Given the small patient number and retrospective nature, our findings should be validated by larger-scale randomized studies.",
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AU - Li, Hsin Ru

AU - Hsu, Chiao Po

AU - Sung, Shih Hsien

AU - Shih, Chun Che

AU - Lin, Shing Jong

AU - Chan, Wan Leong

AU - Wu, Cheng Hsueh

AU - Lu, Tse Min

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N2 - Background: Patients with diabetic nephropathy and unprotected left main (LM) coronary artery disease suffer from high cardiovascular morbidity and mortality. Although surgical revascularization is currently recommended in this special patient population, the optimal revascularization method for this distinct patient group has remained unclear. Methods:We collected 99 consecutive patients with unprotected LMdisease and diabetic nephropathy, including 46 patients who had undergone percutaneous coronary intervention (PCI), and 53 who had coronary artery bypass grafting (CABG), with amean age of 72 ± 10; with 80.8% male. Diabetic nephropathywas defined as overt proteinuria (proteinuria > 500 mg/day) and estimated glomerular filtration rate (eGFR) by the modified Modification of Diet in Renal Disease (MDRD) equation of less than 60 mL/min/1.73m 2 . The baseline characteristics, angiographic results and long-term clinical outcomes were retrospectively analyzed. Results: The baseline characteristic of all patients were similar except for smokers, low density lipoprotein (LDL) level and extension of coronary artery disease involvement. The median follow-up period was 3.8 years. There were 73 patients (74%) considered as high risk with additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≤ 6. During follow-up period, the long term rate of all-cause death (PCI vs. CABG: 45.7% vs. 58.5%, p = 0.20) and all-cause death/myocardial infarction (MI)/stroke (PCI vs. CABG: 52.2% vs. 60.4%, p = 0.41) were comparable between the PCI and CABG group, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI vs. CABG: 32.6% vs. 9.4%, p < 0.01). eGFR remained an independent predictor for all-cause death [hazard ratio: 0.97, 95% confidence interval: 0.96 to 0.99; p = 0.002] in multivariate logistic regression. Conclusions: In the real-world practice of high-risk patients with unprotected LM disease and diabetic nephropathy, we found that PCI was a comparable alternative to CABG in terms of long-term risks of all-cause death/MI/stroke, with significantly higher repeat revascularization rate. Given the small patient number and retrospective nature, our findings should be validated by larger-scale randomized studies.

AB - Background: Patients with diabetic nephropathy and unprotected left main (LM) coronary artery disease suffer from high cardiovascular morbidity and mortality. Although surgical revascularization is currently recommended in this special patient population, the optimal revascularization method for this distinct patient group has remained unclear. Methods:We collected 99 consecutive patients with unprotected LMdisease and diabetic nephropathy, including 46 patients who had undergone percutaneous coronary intervention (PCI), and 53 who had coronary artery bypass grafting (CABG), with amean age of 72 ± 10; with 80.8% male. Diabetic nephropathywas defined as overt proteinuria (proteinuria > 500 mg/day) and estimated glomerular filtration rate (eGFR) by the modified Modification of Diet in Renal Disease (MDRD) equation of less than 60 mL/min/1.73m 2 . The baseline characteristics, angiographic results and long-term clinical outcomes were retrospectively analyzed. Results: The baseline characteristic of all patients were similar except for smokers, low density lipoprotein (LDL) level and extension of coronary artery disease involvement. The median follow-up period was 3.8 years. There were 73 patients (74%) considered as high risk with additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≤ 6. During follow-up period, the long term rate of all-cause death (PCI vs. CABG: 45.7% vs. 58.5%, p = 0.20) and all-cause death/myocardial infarction (MI)/stroke (PCI vs. CABG: 52.2% vs. 60.4%, p = 0.41) were comparable between the PCI and CABG group, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI vs. CABG: 32.6% vs. 9.4%, p < 0.01). eGFR remained an independent predictor for all-cause death [hazard ratio: 0.97, 95% confidence interval: 0.96 to 0.99; p = 0.002] in multivariate logistic regression. Conclusions: In the real-world practice of high-risk patients with unprotected LM disease and diabetic nephropathy, we found that PCI was a comparable alternative to CABG in terms of long-term risks of all-cause death/MI/stroke, with significantly higher repeat revascularization rate. Given the small patient number and retrospective nature, our findings should be validated by larger-scale randomized studies.

KW - Chronic kidney disease

KW - Coronary artery bypass grafting

KW - Diabetes mellitus

KW - Diabetic nephropathy

KW - Left main coronary artery disease

KW - Percutaneous coronary intervention

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