In early-stage diabetic retinopathy, risk of cardiac events after implantation of sirolimus-eluting stent is higher than after coronary artery bypass surgery.
BACKGROUND
Patients with diabetic retinopathy (DR) have an increased risk of death from coronary heart disease and myocardial infarction. The purpose of this study was to compare the outcomes of revascularization strategies (sirolimus-eluting stent [SES] and coronary artery bypass surgery [CABG]) in patients with DR according to the stage of retinopathy: non-proliferative retinopathy (NPDR) and proliferative retinopathy (PDR).


METHODS
From April 2004 until February 2007, 627 patients including 51 NPDR and 62 PDR patients underwent SES implantation. For each retinopathy group, a historical comparison group at the same stages of retinopathy undergoing CABG was selected. Cardiac events were defined as a composite of cardiac death, myocardial infarction, and repeat revascularization.


RESULTS
The average follow-up from the time of the initial revascularization was 27.7 ± 8.5 months for NPDR-SES patients, 69.6 ± 36.6 months for NPDR-CABG patients, 26.4 ± 9.7 months for PDR-SES patients, and 68.3 ± 44.2 months for PDR-CABG patients; and Kaplan-Meier estimates of the percentages of events at 24 months were 47.0%, 22.8%, 28.5%, and 26.0%. Kaplan-Meier curves for cardiac events differed significantly between the SES group and the CABG group in NPDR patients (p = 0.04), whereas the curves did not differ significantly between the two groups of PDR patients. The adjusted hazard ratio of SES implantation for cardiac events in the entire group of DR patients was 1.75 (95% confidence interval [CI] 1.02-3.00, p = 0.04).


CONCLUSIONS
SES implantation is not a suitable method of revascularization in DR patients, especially in NPDR patients. CABG may become the first-choice revascularization technique for these patients.
Masuzawa
Akihiro
A
Department of Cardiothoracic Surgery, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan.
Ohno
Takayuki
T
Takamoto
Shinichi
S
Motomura
Noboru
N
Ono
Minoru
M
Fujita
Hideo
H
Ando
Jiro
J
Morita
Toshihiro
T
Hirata
Yasunobu
Y
Nagai
Ryozo
R
Hirose
Akira
A
Shigeeda
Takashi
T
Kato
Satoshi
S
Araie
Makoto
M
D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000209:etiology*; D003930:Diabetic Retinopathy / Q000150:complications*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
D020123:Sirolimus