Abstract
Introduction.
There is reason to suppose that the results of surgical treatment of coronary artery disease in
patients with type II diabetes mellitus (DM) is still worse in comparison with the general population, and the
optimal strategy of revascularization is still not clear. The aim of our study was to compare the results of five-
year coronary artery bypass grafting (CABG) and percutaneous coronary intervention with implantation of
drug-eluting stents (PCI with DES) in diabetic patients with multivessel coronary artery disease.
Materials and methods.
The study included 379 patients with multivessel coronary artery disease coronary
artery and DM after CABG (n = 282) or after PCI with DES (n = 97). Mean follow-up was 56±11 months.
Analyzed the total five-year survival and survival without the development of "major" cardiovascular events
(death, non-fatal development of myocardial infarction, non-fatal stroke, conducting repeated revascula
rization) in two groups of patients.Results.
There are no significant differences in overall survival and survival without myocardial infarction
over a five year period among diabetic patients after CABG and PCI with DES. However, in patients after
CABG was significantly lower survival without the development of stroke (p = 0.042). Among diabetic
patients after PCI with DES significantly more frequently than in patients after CABG observed the need for
repeat revascularization (p = 0.001). Free survival of the "major" cardiovascular complications was signifi
cantly higher in patients after CABG, with the result that indicated the advantages of this method of revas
cularization in patients with diabetes.
Conclusion.
Five-year survival between patients with diabetes after CABG and PCI with DES is comparable.
However, performance of CABG, to date, is prognostically more favorable method of revascularization,
which is primarily determined by the significant reduction in the need for repeat revascularization.
References
1.
Amos A.F., McCarty D.J., Zimmet P.
The rising glob
al burden of diabetes and its complications:
Estimates and projections to the year 2010.
Diabet.
Med.
1997; 14:1-85.
2.
Бокерия Л.А., Голухова Е.З., Сигаев И.Ю., Ке-
рен М.А.
Современные подходы к хирургичес
кому лечению ИБС у больных с сахарным диа
бетом.
Вестник РАМН.
2012; 1: 20-6.
3.
Tanveer A., Khan P.V., Sellke F.W.
Cardiac surgery
and diabetes mellitus. In: Johnstone M.T., Veves A.
(eds). Diabetes and cardiovascular disease. 2nd ed.
Totowa: Humana Press; 2005: 115-20.
4.
Braunwald E., Antman E.M., Beasley J.W.
et al.
ACC/AHA guidelines for the management of
patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the
American College of Cardiology/American Heart
Association Task Force on Practice Guidelines
(Committee on the Management of Patients With
Unstable Angina).
J. Am. Coll. Cardiol.
2000; 36:
970-1062.
5. The Bypass Angioplasty Revascularization
Investigation (BARI). Investigators comparison of
coronary bypass surgery with angioplasty in patients
with multivessel disease.
N. Engl. J. Med.
1996; 335:
217-25.
6. BARI investigators. Influence of diabetes on 5-year
mortality and morbidity in a randomized trial com
paring CABG and PTCA in patients with multives
sel disease: The Bypass Angioplasty Revascula
rization Investigation (BARI).
Circulation.
1997; 96:
1761-9.
7.
Carson J.L., Scholz P.M., Chen A.Y., Peterson E.D.,
Gold J., Schneider S.H.
Diabetes mellitus increases
short-term mortality and morbidity in patients
undergoing coronary artery bypass graft surgery.
J.
Am. Coll. Cardiol.
2002; 40: 418-23.
8.
Moses J.W., Leon M.B., Popma J.J.
et al. Sirolimus-
eluting stents versus standard stents in patients with
stenosis in a native coronary artery.
N. Engl. J. Med.
2003; 349: 1315-23.
9.
Moussa I., Leon M.B., Baim D.S.
et al. Impact of
sirolimus-eluting stents on outcome in diabetic
patients: A SIRIUS (SIRolImUS-coated Bx
Velocity balloon-expandable stent in the treatment
of patients with de novo coronary artery lesions)
substudy.
Circulation.
2004; 109: 2273-8.
10.
Hermiller J.B., Raizner A., Cannon L.
et al.
Outcomes with the polymer-based paclitaxel-elu-
ting TAXUS stent in patients with diabetes mellitus:
The TAXUS-IV trial.
J. Am. Coll. Cardiol.
2005; 45:
1172-9.
11.
Yang J.H., Gwon H.-C., Cho S.J.
et al. Comparison
of coronary artery bypass grafting with drug-eluting
stent implantation for the treatment of multivessel
coronary artery disease.
Ann. Thorac. Surg.
2008;
85: 65-70.
12.
Lee M.S., Jamal F., Kedia G.
et al. Comparison of
bypass surgery with drug eluting stents for diabetic
patients with multivessel disease.
Int. J. Cardiol
.
2007; 123: 34-42.
13.
Hannan E.L., Wu C., Walford G.
et al. Drug-eluting
stents versus coronary-artery bypass grafting in mul
tivessel coronary disease.
N. Engl. J. Med.
2008;
358: 331-41.
14.
Serruys P.W., Colombo A., Morice M.C.
et al.
Arterial revascularisation therapies study Part II -
sirolimus-eluting stents for the treatment of patients
with multivessel de novo coronary artery lesions.
EuroIntervention.
2005; 1: 147-56.
15.
Rodriguez A.E., Maree A.O., Mieres J.
et al. Late
loss of early benefit from drug-eluting stents when
compared with bare-metal stents and coronary
artery bypass surgery: 3 years follow-up of the
ERACI III registry.
Eur. Heart J.
2007; 28:
2118-25.
16.
Rodriguez A.E., Baldi J., Pereira C.F.
et al. Five-year
follow-up of the Argentine randomized trial of coro
nary angioplasty with stenting versus coronary bypass
surgery in patients with multiple vessel disease
(ERACI II).
J. Am. Coll. Cardiol.
2005; 46: 582-8.17.
Kapur A.
Coronary artery revascularisation in dia
betes. The CARDia trial. European Society of
Cardiology Congress 2008; Munich; 2008: 1694-5.
18.
Serruys P.W., Morice M.C., Kappetein A.P.
et al.
SYNTAX investigators percutaneous coronary
intervention versus coronary-artery bypass grafting
for severe coronary artery disease.
N. Engl. J. Med.
2009; 360: 961-72.
19.
Chaitman B.R., Hardison R.M., Adler D.
et al. The
Bypass Angioplasty Revascularization Investigation
2 Diabetes (BARI 2D) Study Group The Bypass
Angioplasty Revascularization Investigation 2
Diabetes randomized trial of different treatment
strategies in type 2 diabetes mellitus with stable
ischemic heart disease: Impact of treatment strategy
on cardiac mortality and myocardial infarction.
Circulation.
2009; 120: 2529-40.
