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Coronary revascularization in diabetic patients

A focus on the 3-year SYNTAX trial outcomes

Koronararterienrevaskularisierung bei Diabetespatienten

Fokus auf die Ergebnisse der 3-Jahres-Studie SYNTAX

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Abstract

The prevalence of diabetes is growing worldwide. Diabetics are predisposed to coronary artery disease due to an increased rate of atherosclerosis. The optimal treatment for these patients remains uncertain. Randomized trials compared percutaneous coronary intervention (PCI) to coronary artery bypass surgery (CABG) to determine the most suitable revascularization strategy. Meta-analyses suggest a survival advantage in favor of surgery over angioplasty or stenting with bare-metal stents (BMS). New evidence was needed since advances in medical therapy, PCI technology, and surgical techniques have emerged. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was the first to compare a drug-eluting stent to CABG and showed an increased rate of major adverse cardiac or cerebrovascular events after PCI. Results are mainly driven by the increased rates in patients with high lesion complexity; therefore, the current evidence suggests that diabetic patients with complex coronary disease have better outcomes with CABG.

Zusammenfassung

Die Prävalenz des Diabetes mellitus weltweit nimmt zu. Diabetespatienten sind aufgrund einer erhöhten Arterioskleroserate prädisponiert für koronare Herzkrankheit (KHK). Unsicherheit besteht weiterhin darüber, welches die beste Therapie für diese Patienten ist. In randomisierten Studien wurde die perkutane koronare Intervention (PCI) mit der koronaren Bypassoperation (CABG) verglichen, um die geeignetste Revaskularisierungsstrategie zu ermitteln. In Metaanalysen gibt es Hinweise auf einen Überlebensvorteil bei der Operation gegenüber der Angioplastie oder dem Stenting mit unbeschichteten Stents (BMS). Neue Untersuchungen wurden aufgrund von Fortschritten bei der pharmakologischen Therapie, der PCI und operativer Verfahren erforderlich. In der SYNTAX-Studie wurde erstmals ein Medikamente freisetzender Stent mit dem CABG verglichen und eine erhöhte Rate wesentlicher unerwünschter kardialer oder zerebrovaskulärer Ereignisse nach PCI nachgewiesen. Zu den Ergebnissen haben hauptsächlich die erhöhten Raten von Patienten mit hoher Komplexität der Läsionen geführt; demzufolge gibt es bei Diabetespatienten mit komplexer KHK Hinweise auf bessere Verläufe nach Durchführung eines CABG.

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Conflict of interest

The corresponding author states the following: A.P. Kappetein has received institutional research grant support from Boston Scientific.

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Authors and Affiliations

  1. Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, P.O. Box 2040, 3000, CA Rotterdam, The Netherlands

    M.W. Groot, S.J. Head, Ad J.J.C. Bogers & A.P. Kappetein

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  1. M.W. Groot
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  2. S.J. Head
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  3. Ad J.J.C. Bogers
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  4. A.P. Kappetein
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Correspondence to A.P. Kappetein.

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Groot, M., Head, S., Bogers, A. et al. Coronary revascularization in diabetic patients. Herz 37, 281–286 (2012). https://doi.org/10.1007/s00059-012-3602-4

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