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Revascularisation Strategies in Diabetics with Multi-vessel Disease: Factors Influencing Treatment Selection
553 Radial Artery versus Saphenous Vein as the Second Conduit in Coronary Artery Bypass Grafting—A Metaanalysis of Clinical Outcomes J. Edelman ∗ , T. Yan, M. Wilson, P. Bannon, M. Vallely The Baird Institute, Royal Prince Alfred Hospital, The University of Sydney, Australia Background: The superiority of grafting the left internal mammary artery (LIMA) to left anterior descending artery (LAD) is well established. However, the choice of the second best conduit remains less clear. Many trials have collectively compared the right internal mammary artery, radial artery, gastroepiploic artery and saphenous vein – most are retrospective and fail to adequately address the specific question of the second best conduit. Methods: We have performed a meta-analysis of trials comparing the outcomes of patients receiving a radial artery (RA) or saphenous vein (SV) graft to the best target after grafting the LIMA to LAD. We assessed early (<1 y) and late survival (>1 y) as the primary outcome. Results: Eight trials (three randomised, five observational) were identified and compared 2980 patients with LIMA/radial artery grafting with 6158 patients with LIMA/SV grafting. The mean follow-up of trials included in the late follow-up analysis ranged from 5.7 to 7 years. There was no significant difference in mortality early period (1.11% vs 1.67%, RR 0.85, 95% confidence interval [CI] 0.53–1.38, p = 0.52). Mortality was significantly lower in RA group for the late follow-up period (13.55% vs 28.46%, RR 0.63, CI 0.45–0.87, p = 0.005). Conclusion: The results of this meta-analysis suggest that the RA may have a survival benefit over the SV in the early and late post-operative period when grafted to the best target after LIMA to LAD.
Abstracts
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intervention (PCI) is unclear. Therefore, we studied demographic and clinical factors that potentially influenced the choice of revascularisation strategy in MVD diabetic-patients at a tertiary referral centre. Methods and results: From June 2006 to March 2010, 1125 diabetic patients who underwent angiography at our centre were screened for a large international randomised clinical trial(RCT) of revascularisation strategies. Of 394 clinically eligible patients with ≥2 vessel disease, 142 had prior CABG, 41 left main and 24 chronic total occlusion, leaving 145 non randomised patients who underwent PCI or CABG (17 treated medically). Of those with proximalLAD disease (n = 93), 62% had PCI while 38%underwent CABG (p = 0.07). In comparison among those without proximal-LAD disease 79% underwent PCI whereas 21% had CABG (p < 0.05). Patients undergoing PCI were older (68 ± 10 vs 63 ± 11; p = 0.019) with less extensive coronary artery disease (two vs three vessel disease [p < 0.0001]). No differences were noted in gender, non-English speaking background, previous infarction, peripheral vascular disease or serum creatinine levels. Conclusions: Although there was a trend towards CABG in diabetics with proximal LAD disease, older age and presence of a lesser extent of coronary artery disease, favoured PCI as the chosen strategy for revascularisation. Results from the FREEDOM trial may determine whether the revascularisation choices we observed were appropriate with respect to better late outcomes. doi:10.1016/j.hlc.2011.05.558 555 Short and Medium Term Outcomes for Elderly undergoing Surgical Aortic Valve Replacement (SAVR): The Wellington Experience P. Lou ∗ , M. Simmonds, B. Mahon, S. Harding
doi:10.1016/j.hlc.2011.05.557
Capital and Coast DHB, New Zealand
554
Background: Little local data is available on posthospital outcomes for elderly patients treated with SAVR in this era of TAVI. We determined a comprehensive range of outcomes up to 12 months post-operatively. Methods: A retrospective study of 94 consecutive patients aged ≥75 years undergoing AVR ± CABG at Wellington Hospital between 2008 and 2009. Data was obtained from medical records and telephone contact with a 100% follow up being achieved one year post-surgery. Results: The median age was 79 (range 75–87) and the average EUROSCORE 12.3 ± 9.9. All were living independently (own home) pre-operatively (three with home help (HH)). Forty-seven (50%) underwent AVR alone and 47 (50%) AVR ± CABG. Mean time from surgery to discharge was 16 ± 15.2 days (2.4 ± 3.3 ICU days and 6.23 ± 12.50 hospital level rehabilitation days (42% of subjects)). At 30 days death occurred in seven (7.4%), major complications (stroke, MI, renal failure) in 9 (9.6%), reoperation in 13 (13.8%) and readmission in 21 (22.3%). Of those alive at 30 days 82 (94.2%) had returned to independent living in their own home (16% requiring HH). At one year 10 (10.6%)
Revascularisation Strategies in Diabetics with Multivessel Disease: Factors Influencing Treatment Selection L. Hee 1,∗ , R. Dignan 2,3 , W. Ahmed 2 , C. Mussap 1,3 , L. Yang 3 , T. Liza 1,3 , J. French 1,3 1 Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia 2 Department of Cardiothoracic, Liverpool Hospital, Sydney, NSW, Australia 3 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Current guidelines support coronary artery bypass grafting (CABG) as the preferred revascularisation strategy in multi-vessel disease (MVD) diabetic-patients, particularly with significant proximal left-anteriordescending artery (LAD) disease. Whether this occurs in routine clinical practice, or other factors lead to performance of multi-vessel percutaneous coronary
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S156–S251
Abstracts
S227
intervention (PCI) is unclear. Therefore, we studied demographic and clinical factors that potentially influenced the choice of revascularisation strategy in MVD diabetic-patients at a tertiary referral centre. Methods and results: From June 2006 to March 2010, 1125 diabetic patients who underwent angiography at our centre were screened for a large international randomised clinical trial(RCT) of revascularisation strategies. Of 394 clinically eligible patients with ≥2 vessel disease, 142 had prior CABG, 41 left main and 24 chronic total occlusion, leaving 145 non randomised patients who underwent PCI or CABG (17 treated medically). Of those with proximalLAD disease (n = 93), 62% had PCI while 38%underwent CABG (p = 0.07). In comparison among those without proximal-LAD disease 79% underwent PCI whereas 21% had CABG (p < 0.05). Patients undergoing PCI were older (68 ± 10 vs 63 ± 11; p = 0.019) with less extensive coronary artery disease (two vs three vessel disease [p < 0.0001]). No differences were noted in gender, non-English speaking background, previous infarction, peripheral vascular disease or serum creatinine levels. Conclusions: Although there was a trend towards CABG in diabetics with proximal LAD disease, older age and presence of a lesser extent of coronary artery disease, favoured PCI as the chosen strategy for revascularisation. Results from the FREEDOM trial may determine whether the revascularisation choices we observed were appropriate with respect to better late outcomes. doi:10.1016/j.hlc.2011.05.558 555 Short and Medium Term Outcomes for Elderly undergoing Surgical Aortic Valve Replacement (SAVR): The Wellington Experience P. Lou ∗ , M. Simmonds, B. Mahon, S. Harding
doi:10.1016/j.hlc.2011.05.557
Capital and Coast DHB, New Zealand
554
Background: Little local data is available on posthospital outcomes for elderly patients treated with SAVR in this era of TAVI. We determined a comprehensive range of outcomes up to 12 months post-operatively. Methods: A retrospective study of 94 consecutive patients aged ≥75 years undergoing AVR ± CABG at Wellington Hospital between 2008 and 2009. Data was obtained from medical records and telephone contact with a 100% follow up being achieved one year post-surgery. Results: The median age was 79 (range 75–87) and the average EUROSCORE 12.3 ± 9.9. All were living independently (own home) pre-operatively (three with home help (HH)). Forty-seven (50%) underwent AVR alone and 47 (50%) AVR ± CABG. Mean time from surgery to discharge was 16 ± 15.2 days (2.4 ± 3.3 ICU days and 6.23 ± 12.50 hospital level rehabilitation days (42% of subjects)). At 30 days death occurred in seven (7.4%), major complications (stroke, MI, renal failure) in 9 (9.6%), reoperation in 13 (13.8%) and readmission in 21 (22.3%). Of those alive at 30 days 82 (94.2%) had returned to independent living in their own home (16% requiring HH). At one year 10 (10.6%)
Revascularisation Strategies in Diabetics with Multivessel Disease: Factors Influencing Treatment Selection L. Hee 1,∗ , R. Dignan 2,3 , W. Ahmed 2 , C. Mussap 1,3 , L. Yang 3 , T. Liza 1,3 , J. French 1,3 1 Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia 2 Department of Cardiothoracic, Liverpool Hospital, Sydney, NSW, Australia 3 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
Current guidelines support coronary artery bypass grafting (CABG) as the preferred revascularisation strategy in multi-vessel disease (MVD) diabetic-patients, particularly with significant proximal left-anteriordescending artery (LAD) disease. Whether this occurs in routine clinical practice, or other factors lead to performance of multi-vessel percutaneous coronary
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S156–S251