Download PDF
Int J Angiol 2021; 30(03): 187-193
DOI: 10.1055/s-0041-1735517
Review Article

CABG versus PCI in the Treatment of Unprotected Left Main Disease in Diabetics: A Literature Review

Daniel Lambert
1   Department of Cardiac Surgery, North Shore-Long Island Jewish Medical Center, Manhasset, New York
,
Allan Mattia
2   Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, New York
3   Hofstra Northwell School of Medicine, Department of Surgery, Hempstead, New York
,
Angel Hsu
4   Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
,
Frank Manetta 
5   Department of Cardiothoracic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
› Author Affiliations
› Further Information
    Permissions and Reprints

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.

Keywords

PCI - CABG - left main coronary artery disease - stent - acute coronary syndrome - coronary intervention - cardiac


Publication History

Article published online:
10 November 2021

© 2021. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Singh M, Arora R, Kodumuri V, Khosla S, Jawad E. Coronary revascularization in diabetic patients: current state of evidence. Exp Clin Cardiol 2011; 16 (01) 16-22
    PubMedSearch in Google Scholar
  • 2 Farkouh ME, Domanski M, Sleeper LA. et al; FREEDOM Trial Investigators. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367 (25) 2375-2384
    CrossrefPubMedSearch in Google Scholar
  • 3 Kassimis G, Bourantas CV, Tushar R. et al. Percutaneous coronary intervention vs. cardiac surgery in diabetic patients. Where are we now and where should we be going?. Hellenic J Cardiol 2017; 58 (03) 178-189
    CrossrefPubMedSearch in Google Scholar
  • 4 Flaherty JD, Davidson CJ. Diabetes and coronary revascularization. JAMA 2005; 293 (12) 1501-1508
    CrossrefPubMedSearch in Google Scholar
  • 5 Spadaccio C, Benedetto U. Coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease: quo vadis? -a review of the evidences on coronary artery disease. Ann Cardiothorac Surg 2018; 7 (04) 506-515
    CrossrefPubMedSearch in Google Scholar
  • 6 Habibi SE, Shah R, Berzingi CO, Melchior R, Sumption KF, Jovin IS. Left main coronary artery stenosis: severity evaluation and implications for management. Expert Rev Cardiovasc Ther 2017; 15 (03) 157-163
    CrossrefPubMedSearch in Google Scholar
  • 7 Jönsson A, Ivert T, Svane B, Liska J, Jakobsson K, Hammar N. Classification of left main coronary obstruction–feasibility of surgical angioplasty and survival after coronary artery bypass surgery. Cardiovasc Surg 2003; 11 (06) 497-505
    CrossrefPubMedSearch in Google Scholar
  • 8 Kamalesh M, Sharp TG, Tang XC. et al; VA CARDS Investigators. Percutaneous coronary intervention versus coronary bypass surgery in United States veterans with diabetes. J Am Coll Cardiol 2013; 61 (08) 808-816
    CrossrefPubMedSearch in Google Scholar
  • 9 Kapur A, Hall RJ, Malik IS. 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 (05) 432-440
    CrossrefPubMedSearch in Google Scholar
  • 10 Park D-W, Ahn J-M, Park H. et al; PRECOMBAT Investigators. Ten-year outcomes after drug-eluting stents versus coronary artery bypass grafting for left main coronary disease: extended follow-up of the PRECOMBAT trial. Circulation 2020; 141 (18) 1437-1446
    CrossrefPubMedSearch in Google Scholar
  • 11 Stefanini GG, Byrne RA, Serruys PW. et al. Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: a pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials. Eur Heart J 2012; 33 (10) 1214-1222
    CrossrefPubMedSearch in Google Scholar
  • 12 Gaudino M, Angiolillo DJ, Di Franco A. et al. Stroke after coronary artery bypass grafting and percutaneous coronary intervention: incidence, pathogenesis, and outcomes. J Am Heart Assoc 2019; 8 (13) e013032
    CrossrefPubMedSearch in Google Scholar
  • 13 Chandrasekhar J, Martin K, Mehran R. Role of coronary drug-eluting stents in current clinical practice. The Pharmaceutical Journal 2016; 8: 11
    PubMedSearch in Google Scholar
  • 14 Stone GW, Sabik JF, Serruys PW. et al; EXCEL Trial Investigators. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med 2016; 375 (23) 2223-2235
    CrossrefPubMedSearch in Google Scholar
  • 15 Dai X, Luo ZC, Zhai L, Zhao WP, Huang F. Reassessing coronary artery bypass surgery versus percutaneous coronary intervention in patients with type 2 diabetes mellitus: a brief updated analytical report (2015-2017). Diabetes Ther 2018; 9 (05) 2163-2171
    CrossrefPubMedSearch in Google Scholar
  • 16 Xin X, Wang X, Dong X. et al. Efficacy and safety of drug-eluting stenting compared with bypass grafting in diabetic patients with multivessel and/or left main coronary artery disease. Scientific Reports 2019;09(7268)
    PubMed
  • 17 Mack MJ, Banning AP, Serruys PW. et al. Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome. Ann Thorac Surg 2011; 92 (06) 2140-2146
    CrossrefPubMedSearch in Google Scholar
  • 18 Verma S, Farkouh ME, Yanagawa B. et al. Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol 2013; 1 (04) 317-328
    CrossrefPubMedSearch in Google Scholar
  • 19 Cui K, Lyu S, Song X. et al. Drug-eluting stent versus coronary artery bypass grafting for diabetic patients with multivessel and/or left main coronary artery disease: a meta-analysis. Angiology 2019; 70 (08) 765-773
    CrossrefPubMedSearch in Google Scholar
  • 20 Zhai C, Cong H, Hou K, Hu Y, Zhang J, Zhang Y. Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies. Diabetol Metab Syndr 2019; 11: 110
    CrossrefPubMedSearch in Google Scholar
  • 21 Weimer M, Stoikovic S, Samol A. et al. Third generation drug eluting stent (DES) with biodegradable polymer in diabetic patients: 5 years follow-up. Cardiovascular Diabetology 2017;16(23):
    PubMed
  • 22 Castelvecchio S, Menicanti L, Garatti A, Tramarin R, Volpe M, Parolari A. Myocardial revascularization for patients with diabetes: coronary artery bypass grafting or percutaneous coronary intervention?. Ann Thorac Surg 2016; 102 (03) 1012-1022
    CrossrefPubMedSearch in Google Scholar
  • 23 Al Ali J, Franck C, Filion KB, Eisenberg MJ. Coronary artery bypass graft surgery versus percutaneous coronary intervention with first-generation drug-eluting stents: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv 2014; 7 (05) 497-506
    CrossrefPubMedSearch in Google Scholar
  • 24 Hoole SP, Bambrough P. Recent advances in percutaneous coronary intervention. Heart 2020; 106 (18) 1380-1386
    CrossrefPubMedSearch in Google Scholar
  • 25 Raja S, Garg S, Rochon M. et al. Short-term clinical outcomes and long-term survival of minimally invasive direct coronary artery bypass grafting. Annals of Cardiothoracic Surgery 2018; 07 (05) 621-627
    CrossrefPubMedSearch in Google Scholar
  • 26 Lehto HR, Pietilä A, Niiranen TJ, Lommi J, Salomaa V. Clinical practice patterns in revascularization of diabetic patients with coronary heart disease: nationwide register study. Ann Med 2020; 52 (05) 225-232
    CrossrefPubMedSearch in Google Scholar