Revascularization trends in patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST elevation myocardial infarction

Ambarish Pandey, Darren K. McGuire, James A. De Lemos, Sandeep R. Das, Jarett D. Berry, Emmanouil S. Brilakis, Subhash Banerjee, Steven P. Marso, Gregory W. Barsness, Da Juanicia N Simon, Matthew Roe, Abhinav Goyal, Mikhail Kosiborod, Ezra A Amsterdam, Dharam J. Kumbhani

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background - Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction. Methods and Results - Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4%) were treated with CABG, 13 760 (46.2%) were treated with PCI, and 5157 (17.3%) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45% to 48.9%; P trend =0.0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; p trend =0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22%-100%; 0%-78%, respectively; P value <0.0001 for both). Patient-level, but not hospital-level, characteristics were statistically associated with the use of PCI versus CABG, including anatomic severity of the disease, early treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure. Conclusions - Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years.

Original languageEnglish (US)
Pages (from-to)197-205
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Volume9
Issue number3
DOIs
StatePublished - May 1 2016

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Coronary Artery Bypass
Percutaneous Coronary Intervention
Coronary Artery Disease
Diabetes Mellitus
Transplants
Purinergic P2Y Receptor Antagonists
Guidelines
Non-ST Elevated Myocardial Infarction
Registries
Angiography
Heart Failure
Logistic Models
Regression Analysis

Keywords

  • coronary artery bypass graft surgery
  • diabetes mellitus
  • myocardial infarction
  • non-ST-segment elevation acute coronary syndrome
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Revascularization trends in patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST elevation myocardial infarction. / Pandey, Ambarish; McGuire, Darren K.; De Lemos, James A.; Das, Sandeep R.; Berry, Jarett D.; Brilakis, Emmanouil S.; Banerjee, Subhash; Marso, Steven P.; Barsness, Gregory W.; Simon, Da Juanicia N; Roe, Matthew; Goyal, Abhinav; Kosiborod, Mikhail; Amsterdam, Ezra A; Kumbhani, Dharam J.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 9, No. 3, 01.05.2016, p. 197-205.

Research output: Contribution to journalArticle

Pandey, A, McGuire, DK, De Lemos, JA, Das, SR, Berry, JD, Brilakis, ES, Banerjee, S, Marso, SP, Barsness, GW, Simon, DJN, Roe, M, Goyal, A, Kosiborod, M, Amsterdam, EA & Kumbhani, DJ 2016, 'Revascularization trends in patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST elevation myocardial infarction', Circulation: Cardiovascular Quality and Outcomes, vol. 9, no. 3, pp. 197-205. https://doi.org/10.1161/CIRCOUTCOMES.115.002084
Pandey, Ambarish ; McGuire, Darren K. ; De Lemos, James A. ; Das, Sandeep R. ; Berry, Jarett D. ; Brilakis, Emmanouil S. ; Banerjee, Subhash ; Marso, Steven P. ; Barsness, Gregory W. ; Simon, Da Juanicia N ; Roe, Matthew ; Goyal, Abhinav ; Kosiborod, Mikhail ; Amsterdam, Ezra A ; Kumbhani, Dharam J. / Revascularization trends in patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST elevation myocardial infarction. In: Circulation: Cardiovascular Quality and Outcomes. 2016 ; Vol. 9, No. 3. pp. 197-205.
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abstract = "Background - Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction. Methods and Results - Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4{\%}) were treated with CABG, 13 760 (46.2{\%}) were treated with PCI, and 5157 (17.3{\%}) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45{\%} to 48.9{\%}; P trend =0.0002) and no change in the proportion undergoing CABG (36.1{\%} to 34.7{\%}; p trend =0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22{\%}-100{\%}; 0{\%}-78{\%}, respectively; P value <0.0001 for both). Patient-level, but not hospital-level, characteristics were statistically associated with the use of PCI versus CABG, including anatomic severity of the disease, early treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure. Conclusions - Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years.",
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T1 - Revascularization trends in patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST elevation myocardial infarction

AU - Pandey, Ambarish

AU - McGuire, Darren K.

AU - De Lemos, James A.

AU - Das, Sandeep R.

AU - Berry, Jarett D.

AU - Brilakis, Emmanouil S.

AU - Banerjee, Subhash

AU - Marso, Steven P.

AU - Barsness, Gregory W.

AU - Simon, Da Juanicia N

AU - Roe, Matthew

AU - Goyal, Abhinav

AU - Kosiborod, Mikhail

AU - Amsterdam, Ezra A

AU - Kumbhani, Dharam J.

PY - 2016/5/1

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N2 - Background - Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction. Methods and Results - Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4%) were treated with CABG, 13 760 (46.2%) were treated with PCI, and 5157 (17.3%) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45% to 48.9%; P trend =0.0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; p trend =0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22%-100%; 0%-78%, respectively; P value <0.0001 for both). Patient-level, but not hospital-level, characteristics were statistically associated with the use of PCI versus CABG, including anatomic severity of the disease, early treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure. Conclusions - Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years.

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KW - coronary artery bypass graft surgery

KW - diabetes mellitus

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KW - non-ST-segment elevation acute coronary syndrome

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