论文部分内容阅读
Objective This study was conducted to evaluate the impact of diabetes on patients with unprotected left main coronary artery (LMCA) disease treated with either percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG).Background The optimal coronary revascularization strategy indiabetic patients with unprotected LMCA disease remains uncertain.Methods 823 consecutive patients having unprotected LMCA disease, who received drug-eluting stents (DES) (n=331) implantation or underwent CABG (n=492) were retrospectively analyzed.We compared the effects of these 2 treatments on clinical outcomes (death, cardiac death, myocardial infarction, stroke, target vessel revascularization and the composite of death, myocardial infarction, or stroke), according to diabetic status.Results After multivariable adjustment, the risk of death (hazard ratio [HR]: 1.096, 95% confidence interval [CI]: 0.541 to 2.222, p=0.799) and the composite of death, myocardial infarction, or stroke (HR: 0.769, 95% CI: 0.446 to 1.328, p=0.346) were similar in the DES and CABG groups.However, the rate of TVR was significantly higher in the DES group (HR: 0.169, 95% CI: 0.079 to 0.358, p<0.001).Incidence ofMI (HR: 1.314, 95% CI: 0.238 to 7.254, p=0.754) and the composite of death, MI, or stroke (HR: 1.497, 95% CI: 0.682 to 3.289, p=0.315) were similar between DES and CABG in the nondiabetic group, but in the diabetic population incidence of the composite of death, MI, or stroke (HR: 0.31, 95% CI: 0.126 to 0.761, p=0.011) was significantly higher in DES compared to CABG group, mainly driven by the significant higher rate of MI with DES group (HR: 0.114, 95% CI: 0.022 to 0.593, p=0.01).Rate of repeat revascularization was higher with DES compared with CABG in both diabetic and nondiabetic group.Conclusion There was a prognostic impact of DM on treatment effects in patients with unprotected LMCA lesion who underwent DES or CABG.For patients with unprotected LMCA lesion, PCI with DES was an acceptable alternative to CABG at risk of higher repeat revascularization in the nondiabetic cohort whereas in the diabetic cohort PCI with DES was inferior to CABG in terms of both safety and efficacy.