Coronary artery bypass grafting versus coronary implantation of sirolimus-eluting stents in patients with diabetic retinopathy.
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.
Ohno
Takayuki
T
Department of Cardiothoracic Surgery, The University of Tokyo, Tokyo, Japan. takohno-tky@umin.net
Takamoto
Shinichi
S
Motomura
Noboru
N
Ono
Minoru
M
Ando
Jiro
J
Morita
Toshihiro
T
Fujita
Hideo
H
Hirata
Yasunobu
Y
Nagai
Ryozo
R
Shigeeda
Takashi
T
Hirose
Akira
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents
D020123:Sirolimus