title: Bypass versus drug-eluting stents at three years in SYNTAX patients with diabetes mellitus or metabolic syndrome.
abstract: BACKGROUND
  Diabetes mellitus increases adverse outcomes after coronary revascularization; however, the impact of metabolic syndrome is unclear. We examined the impact of diabetes and metabolic syndrome on coronary artery bypass graft surgery (CABG) and stenting outcomes to determine the optimal revascularization option for the treatment of complex coronary artery disease.
  
  
  METHODS
  Patients (n = 1,800) with left main or three-vessel disease or both were randomly allocated to treatment with a TAXUS Express(2) paclitaxel-eluting stent (PES) or CABG, and were included in predefined nondiabetic (n = 1,348) or diabetic subgroups (n = 452); 258 patients with diabetes also had metabolic syndrome.
  
  
  RESULTS
  Among diabetic patients, the 3-year major adverse cardiac and cerebrovascular event (MACCE) rate (22.9% CABG, 37.0% PES; p = 0.002) and revascularization rate (12.9% CABG, 28.0% PES; p < 0.001) were higher after PES treatment. Diabetes increased MACCE rates among PES-treated patients, but had little impact on results after CABG. Compared with CABG, PES treatment yielded comparable MACCE in diabetic patients (30.5% versus 29.8%, p =0.98) and nondiabetic patients (20.2% versus 20.3%, p =0.99) with low Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) study scores of 22 or less. For patients with SYNTAX Scores of 33 or greater, MACCE rates were lower with CABG (18.5% versus 45.9%, p < 0.001 diabetic; 19.8% versus 30.0%, p = 0.01 nondiabetic). Metabolic syndrome did not significantly predict MACCE or repeat revascularization.
  
  
  CONCLUSIONS
  These exploratory analyses suggest that among diabetic patients with complex left main or three-vessel disease, or both, 3-year MACCE is higher after PES compared with CABG. Although PES is a potential treatment option in patients with less complex lesions, CABG should be the revascularization option of choice for patients with more complex anatomic disease, especially with concurrent diabetes. Metabolic syndrome had little impact on 3-year outcomes.
authors.affiliation: Heart Hospital Baylor Plano, Baylor Healthcare System, Dallas, Texas, USA. michael.mack@baylorhealth.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Banning
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Yves
authors.initials: Y
authors.lastname: Taeymans
authors.forename: Guido
authors.initials: G
authors.lastname: Van Nooten
authors.forename: Gianfederico
authors.initials: G
authors.lastname: Possati
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Hood
authors.forename: Katrin
authors.initials: K
authors.lastname: Leadley
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D048909:Diabetes Complications; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged