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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

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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)
강도윤강수진김영학김주현박덕우박성욱박승정박한빛안정민양유진이승환이정훈이철환이필형정영진최경진현준호
Issued Date
2021
Type
Article
Keyword
AgedCoronary Artery Bypass / adverse effects*Coronary Artery Bypass / mortalityCoronary Artery Disease / mortalityCoronary Artery Disease / therapy*Diabetes Mellitus / epidemiology*Drug-Eluting Stents*FemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedPercutaneous Coronary Intervention / adverse effectsPercutaneous Coronary Intervention / instrumentation*Percutaneous Coronary Intervention / mortalityProportional Hazards ModelsRepublic of KoreaRetrospective StudiesRisk FactorsSirolimus / administration & dosageTime FactorsTreatment 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
Appears in Collections:
Medicine > Medicine
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