Original title: Coronary artery bypass graft versus percutaneous coronary intervention with drug-eluting stent implantation for diabetic patients with unprotected left main coronary artery disease: D-DELTA registry. Reference: Meliga Emanuele, et al. EuroIntervention 2013; 9:803-808

Diabetes increases cardiovascular risk events because of their involvement in diffuse form of the vessels, thereby generating more events and changes in revascularization strategy quite often.

826 diabetic patients with lesion of unprotected left main trunk (LMT) with or without lesions in other vessels were included in the “all- comers” registry; of which 520 received angioplasty and 306 CABG. Both populations were similar for most baseline characteristics. 70% did not require insulin and most of them entered to the registry in the context of non ST-segment elevation acute coronary syndrome. The group receiving angioplasty had a higher incidence of renal failure and lower SYNTAX score (29.6 ± 13.3 versus 40.5 ± 13, P < 0.001). Half of the angioplasty group received two stents in LMT, the most common technique, the stent crushing followed by V and T stenting. Only 28.7 % received coronary intravascular ultrasound (IVUS). The rate of in-hospital events was higher in the surgery group due to a higher incidence of perioperative stroke. After almost 3 years of follow up combined event rate (death, myocardial infarction, stroke and revascularization) was higher in the angioplasty group (31.9 % versus 21.6 %, P < 0.01) due to increased revascularization of both the vessel and the target lesion. Excluding revascularization, survival free of myocardial infarction and stroke was similar between both groups.

Conclusion

In diabetic patients with unprotected left main trunk (LMT) with or without lesions to other vessels, angioplasty and CABG have similar results in terms of death, myocardial infarction and stroke. In the long run, the difference in favor of surgery was suitable, mainly to lower revascularization. 

Comment

This analysis of “real life ” shows us , as in all comparing angioplasty and surgery in multiple vessel lesions, that the results are similar over short term, but in the in follow up angioplasty has more events due to the greater revascularization both in the vessel and lesion. It is important to mention that only first-generation drug-eluting stents were used, the most commonly used technique was the crushing and the IVUS was used in less than 30%. 

Courtesy Dr. Carlos Fava
Interventional cardiologist
Favaloro Foundation – Buenos Aires

Dr. Carlos Fava para SOLACI.ORG