ABSTRACT
Background: Diabetic patients are a group of primary interest in the study of myocardial revascularization. Aim: To compare coronary artery bypass grafting surgery (CABG) and percutaneous angioplasty with stents (PCI-S) in diabetic patients with coronary three-vessel or left main coronary artery disease. Material and Methods: Meta-analysis of MEDLINE randomized controlled studies comparing CABG and PCI-S in diabetic patients. The primary outcome measure was major adverse cardiovascular events (MACCE), death, myocardial infarction, cerebrovascular accident (CVA) and coronary re-intervention. Secondary outcomes were the individual components of MACCE. Results: Three studies comparing CABG and PCI-S met the inclusion criteria. One thousand sixty two patients were studied: 565 in the CABG group and 597 in the PCI-S group. At one year follow up MACCE occurred in 24.9 and 12.7% of patients in PCI-S and CABG groups, respectively (Odds ratio (OR) 2.27; 95% confidence intervals (CI) 1.66-3.09). There were no differences in death or myocardial infarction. Strokes were less common in the PCI-S group (OR 0.25, 95% CI0.09-0.68) and coronary re-intervention was required with higher frequency in the PCI-S group (OR 5.32, 95% CI 3.27-8.67). Conclusions: In diabetic patients with three-vessel coronary disease or left main coronary artery, revascularization with CABG had significantly less MACCE at one year than those treated with PCI-S. Stroke frequency was higher in CABG, coronary re-intervention was higher in PCI-S. These results must be interpreted cautiously.
Subject(s)
Humans , Angioplasty , Coronary Artery Bypass , Coronary Artery Disease/therapy , Diabetic Cardiomyopathies/therapy , Stents , Controlled Clinical Trials as Topic , Odds RatioABSTRACT
We compared the short and long term results of isolated aortic valve replacement in 98 patients receiving a Starr-Edwards (SE) prosthesis from 1965 to 1974 and 80 pts receiving a Bjork-Shiley (BS) prosthesis from 1973 to 1981 at our institution. Operative mortality was 20% (SE) and 6% (BS). Follow up information was obtained in 88% (SE) and 96% (BS) of pts discharged alive. The mean period of follow up was 8.2 and 6.7 years respectively. the 5 and 10 year acturial survival rates were 72% and 61% (SE) vs 89% and 83% (BS). Complications per 100 pt-years among pts with SE and those with BS were: systemic emboli 2.8 vs 0.6, major hemorrhagic events 1.25 vs 1.36, perivalvular leak 1.6 vs 1.15, endocarditis 0.31 vs 0.39, prosthetic thrombosis 0 vs 0.58 and ball variance 0.47 vs 0m respectively. Some of these differences may reflect shortcomings of the initial surgical experience during the period in which the SE prothesis was used, rather than different performance of both valves
Subject(s)
Heart Valve Prosthesis/mortality , Follow-Up Studies , Aortic Valve/surgeryABSTRACT
We followed 25 patients operated on for Wolff-Parkinson-White syndrome between august 1985 and octuber 1989. Their mean age was 37 ñ 12 years and arrhythmia had been present for 5 to 30 years. A mean of 3.3 ñ 1.2 years antiarrhytmic agents had failed in controlling rrecurrences. Tachycardia was orthodromic in 21 patients and antidromic in 1, while 3 patients presented rapid atrial fibrillation with hemodynamic deterioration. Drug refractoriness (n = 23) or intolerance (n = 2) were the main surgical indications. The location of accessory pathways was lateral in 19 patients, anteroseptal in 3, posteroseptal in 2, postero lateral in 1 and right lateral in 1 patient. One patient hada a double pathway. There was no surgical mortality. After a follow-up period ranging from 1 to 50 months reccurence of arrythmia was observed in one patient and electrophysiologic evaluation showed persistance of a left lateral pathway in another. The remaining 24 patients are free of symptoms at the end of follow up. Thus, surgical treatment is a curative therapy for most patients with WPW