한빛사논문
- 조회376
Hoyun Kim MD a∗, Do-Yoon Kang MD a∗, Jung-Min Ahn MD a, Jinho Lee MD a, Yeonwoo Choi MD a, Seung Ho Hur MD b, Hun-Jun Park MD c, Damras Tresukosol MD d, Woong Chol Kang MD e, Hyuck Moon Kwon MD f, Seung-Woon Rha MD g, Do-Sun Lim MD h, Myung-Ho Jeong MD i, Bong-Ki Lee MD j, He Huang MD k, Young-Hyo Lim MD l, Jang Ho Bae MD m, Byung Ok Kim MD n, Tiong Kiam Ong MD o, Sung Gyun Ahn MD p, Cheol-Hyun Chung MD a, Duk-Woo Park MD a, Seung-Jung Park MD a on behalf of the BEST Extended Follow-Up Study Investigators
aHeart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
bKeimyung University Dongsan Medical Center, Daegu, Korea
cCatholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
dSiriraj Hospital, Bangkok, Thailand
eGachon University Gil Hospital, Incheon, Korea
fGangnam Severance Hospital, Seoul, Korea
gKorea University Guro, Seoul, Korea
hAnam Hospital, Seoul, Korea
iChonnam National University Hospital, Gwangju, Korea
jKangwon National University Hospital, Chuncheon, Korea
kSir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
lHanyang University Hospital, Seoul, Korea
mKonyang University Hospital, Daejeon, Korea
nInje University Sanggye Paik Hospital, Seoul, Korea
oSarawak General Hospital, Kuching, Sarawak, Malaysia
pYonsei University Wonju Severance Christian Hospital, Wonju, Korea
Address for correspondence: Dr Jung-Min Ahn
Abstract
Background: Diabetes mellitus is associated with more complex coronary artery diseases. Coronary artery bypass grafting (CABG) is a preferred revascularization strategy over percutaneous coronary intervention (PCI) in diabetics with multivessel coronary artery disease (MVD).
Objectives: This study sought to examine the different prognostic effects of revascularization strategies according to the diabetes status from the randomized BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease) trial.
Methods: Patients (n = 880) with MVD were randomly assigned to undergo PCI with an everolimus-eluting stent vs CABG stratified by diabetics (n = 363) and nondiabetics (n = 517). The primary endpoint was the composite of death, myocardial infarction, or target vessel revascularization during a median follow-up of 11.8 years (IQR: 10.6-12.5 years).
Results: In diabetics, the primary endpoint rate was significantly higher in the PCI group than in the CABG group (43% and 32%; HR: 1.53; 95% CI: 1.12-2.08; P = 0.008). However, in nondiabetics, no significant difference was found between the groups (PCI group, 29%; CABG group, 29%; HR: 0.97; 95% CI: 0.67-1.39; P = 0.86; Pinteraction= 0.009). Irrespective of the presence of diabetes, no significant between-group differences were found in the rate of a safety composite of death, myocardial infarction, or stroke and mortality rate. However, the rate of any repeat revascularization was significantly higher in the PCI group than in the CABG group.
Conclusions: In diabetics with MVD, CABG was associated with better clinical outcomes than PCI. However, the mortality rate was similar between PCI and CABG irrespective of diabetes status during an extended follow-up. (Ten-Year Outcomes of Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST Extended], NCT05125367; Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease [BEST], NCT00997828).
논문정보
- Research article
- 2023년 10월 (BRIC 등록일 2023-10-18)
- 국내(교신)+국외 연구진
- 의약학 > 응용의학
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