Improved long-term survival with coronary artery bypass graft surgery compared to percutaneous coronary intervention in diabetics with multivessel disease
Notice bibliographique
Résumé
Abstract Background While randomized clinical trials have demonstrated the superiority of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in patients with diabetes and multivessel coronary artery disease (CAD), there remains a paucity of observational evidence comparing these two modalities. Methods Clinical and administrative databases for Canada's most populous province, Ontario, were linked to obtain records of all patients with angiographic evidence of multivessel CAD (defined as: 2-vessel and 3-vessel disease) treated with either isolated CABG or PCI from October 2008 to March 2017. Left main disease was excluded in the primary analysis. Baseline characteristics of patients undergoing CABG and PCI were compared and 1:1 propensity score matching was performed to account for baseline differences. 30-day mortality was compared in the matched groups. Late mortality and the composite of major cardiovascular and cerebrovascular events (MACCE, consisting of stroke, myocardial infarction (MI), repeat revascularization, and death) were compared between the matched groups using a stratified log rank test and Cox-proportional hazards model. The individual non-fatal components of MACCE were compared using the Fine-Gray model that accounted for death as a competing risk. A secondary analysis that included patients with left main disease was also performed for the outcome of late mortality. A sensitivity analysis that excluded patients with acute coronary syndrome was also conducted for late mortality. Results A total of 9,395 and 4,016 patients underwent CABG and PCI respectively. Prior to matching, CABG patients were younger (65.7 vs 68.5 years, p<0.001), more likely male (78% vs 73%, p<0.001) and with more severe CAD. Propensity score matching based on 24 baseline covariates yielded 3,782 well-balanced pairs. There was no difference in early mortality between CABG and PCI (2.3% vs 2.5%, p=0.65). The rate of all-cause mortality over 8-years was significantly higher with PCI compared to CABG (Figure- HR: 1.35, 95% CI: 1.23–1.50). The cumulative incidence of MI (HR 1.91, 95% CI: 1.66–2.20) and need for repeat revascularization (HR: 4.06, 95% CI: 3.54–4.66) were significantly higher with PCI over 8 years. There was no difference in late stroke between PCI and CABG (stroke (HR: 0.85, 95% CI: 0.68–1.07). Overall MACCE was higher in PCI compared to CABG (HR: 1.94, 95% CI: 1.80–2.09). In our secondary analysis that included patients with left main disease, findings were robust and late mortality remained higher with PCI compared to CABG (HR: 1.42, 95% CI: 1.30–1.54). In a sensitivity analysis where patients with acute coronary syndrome at the time of presentation were excluded, late mortality remained higher with PCI (HR: 1.30, 95% CI: 1.12–1.49) in 2,028 matched pairs. Conclusions In patients with multivessel CAD and diabetes we observed improved long-term mortality and freedom from MACCE at 8-years with CABG compared to PCI. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Canadian Institutes of Health Research
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».