Ten-year Outcomes After Drug-Eluting Stents or Bypass Surgery for Left Main Coronary Disease in Patients With and Without Diabetes Mellitus: The PRECOMBAT Extended Follow-Up Study
- Abstract
- BACKGROUND: Several trials reported differential outcomes after percutaneous coronary intervention with drug-eluting stents (DES) and coronary-artery bypass grafting (CABG) for multivessel coronary disease according to the presence of diabetes mellitus (DM). However, it is not well recognized how DM status affects very-long-term (10-year) outcomes after DES and CABG for left main coronary artery disease.
METHODS AND RESULTS: In the PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) trial, patients with LMCA were randomly assigned to undergo PCI with sirolimus-eluting stents (n=300) or CABG (n=300). The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (MACCE; a composite of death from any cause, myocardial infarction, stroke, or ischemia-driven target-vessel revascularization). Outcomes were examined in patients with (n=192) and without (n=408) medically treated diabetes. The follow-up was extended to at least 10 years for all patients (median, 11.3 years). The 10-year rates of MACCE were not significantly different between DES and CABG in patients with DM (36.3% versus 26.7%, respectively; hazard ratio [HR], 1.35; 95% CI, 0.83-2.19; P=0.23) and without DM (25.3% versus 22.9%, respectively; HR, 1.15; 95% CI, 0.79-1.67; P=0.48) (P-for-interaction=0.48). There were no significant between-group differences in composite of death, MI, or stroke, and all-cause mortality, regardless of DM status. TVR rates were consistently higher after DES than CABG.
CONCLUSIONS: In this 10-year extended follow-up of PRECOMBAT, we found no significant difference between DES and CABG with respect to the incidences of MACCE, serious composite outcome, and all-cause mortality in patients with and without DM with LMCA disease. However, owing to the limited number of patients and no adjustment for multiple testing, overall findings should be considered hypothesis-generating, highlighting the need for further research.
- Author(s)
- 강도윤; 강수진; 김영학; 김주현; 박덕우; 박성욱; 박승정; 박한빛; 안정민; 양유진; 이승환; 이정훈; 이철환; 이필형; 정영진; 최경진; 현준호
- Issued Date
- 2021
- Type
- Article
- Keyword
- Aged; Coronary Artery Bypass / adverse effects*; Coronary Artery Bypass / mortality; Coronary Artery Disease / mortality; Coronary Artery Disease / therapy*; Diabetes Mellitus / epidemiology*; Drug-Eluting Stents*; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Percutaneous Coronary Intervention / adverse effects; Percutaneous Coronary Intervention / instrumentation*; Percutaneous Coronary Intervention / mortality; Proportional Hazards Models; Republic of Korea; Retrospective Studies; Risk Factors; Sirolimus / administration & dosage; Time Factors; Treatment Outcome
- DOI
- 10.1161/JAHA.120.019834
- URI
- https://oak.ulsan.ac.kr/handle/2021.oak/7074
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2550260888&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Ten-year%20Outcomes%20After%20Drug-Eluting%20Stents%20or%20Bypass%20Surgery%20for%20Left%20Main%20Coronary%20Disease%20in%20Patients%20With%20and%20Without%20Diabetes%20Mellitus:%20The%20PRECOMBAT%20Extended%20Follow-Up%20Study&offset=0&pcAvailability=true
- Publisher
- JOURNAL OF THE AMERICAN HEART ASSOCIATION
- Location
- 미국
- Language
- 영어
- ISSN
- 2047-9980
- Citation Volume
- 10
- Citation Number
- 14
- Citation Start Page
- 0
- Citation End Page
- 0
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