Coronary Artery Bypass Grafting Versus Coronary Implantation of Sirolimus-Eluting Stents in Patients with Diabetic Retinopathy

• Published in: The Annals of thoracic surgery Vol. 84; no. 5; pp. 1474 - 1478
• Main Authors: Ohno, Takayuki, MD, Takamoto, Shinichi, MD, Motomura, Noboru, MD, Ono, Minoru, MD, Ando, Jiro, MD, Morita, Toshihiro, MD, Fujita, Hideo, MD, Hirata, Yasunobu, MD, Nagai, Ryozo, MD, Shigeeda, Takashi, MD, Hirose, Akira, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2007; Elsevier Science
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Coronary Artery Bypass; Coronary Disease - therapy; Coronary heart disease; Diabetes. Impaired glucose tolerance; Diabetic Retinopathy - complications; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Retrospective Studies; Sirolimus - administration & dosage; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; 23; Endocrinopathy; Human; Retinopathy; Respiratory disease; Diabetes mellitus; Instrumentation therapy; Cardiovascular disease; Implantation; Patient; Thorax; Coronary heart disease; Stent; Coated material; Eye disease; Coronary artery bypass; Graft; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2007.06.029

Background We compared the 1-year outcome of coronary revascularization with sirolimus-eluting stents (SESs) or coronary artery bypass grafting (CABG) for coronary artery disease involving the left anterior descending artery (LAD) in diabetic patients according to their retinal status: no diabetic retinopathy (NDR) and diabetic retinopathy (DR). Methods Between April 2004 and October 2005, 220 consecutive patients with coronary artery disease involving the LAD underwent implantation of SESs; of these, 25 patients had NDR and 54 had DR. For each group, we included a comparison group of diabetic patients who had undergone CABG and had the same retinal status. Results During 1 year after revascularization, five cardiac events (cardiac death, myocardial infarction, and repeat revascularization) were noted in NDR-SES patients, four in NDR-CABG, 24 in DR-SES, and eight in DR-CABG patients. Most cardiac events were repeat revascularizations. Kaplan-Meier estimates of the incidence of cardiac events at 1 year were 21.1%, 11.4%, 44.0%, and 14.0%, respectively. Kaplan-Meier curves for cardiac events in SES patients were different from those of CABG patients for the DR group ( p = 0.003), but not NDR groups. After adjustments for the potential confounders, the hazard ratio of cardiac events in DR-SES patients was 2.8 (95% confidence interval, 1.1 to 6.9; p = 0.02). Conclusions Compared with SES implantation, CABG is more suitable for revascularization in patients with coronary artery disease involving the LAD and DR.