Cargando…

Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease

In diabetes patients with chronic ≥3 vessel disease, coronary artery bypass grafting (CABG) holds a class I recommendation in the American College of Cardiology and American Heart Association (ACC/AHA) 2011 guidelines, and this classification has not changed to date. Much of the literature has focus...

Descripción completa

Detalles Bibliográficos
Autores principales: Rumana, Umme, Kones, Richard, Taheer, Montather O., Elsayed, Mohamed, Johnson, Craig W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956319/
https://www.ncbi.nlm.nih.gov/pubmed/31752091
http://dx.doi.org/10.3390/jcdd6040041
_version_ 1783487131963883520
author Rumana, Umme
Kones, Richard
Taheer, Montather O.
Elsayed, Mohamed
Johnson, Craig W.
author_facet Rumana, Umme
Kones, Richard
Taheer, Montather O.
Elsayed, Mohamed
Johnson, Craig W.
author_sort Rumana, Umme
collection PubMed
description In diabetes patients with chronic ≥3 vessel disease, coronary artery bypass grafting (CABG) holds a class I recommendation in the American College of Cardiology and American Heart Association (ACC/AHA) 2011 guidelines, and this classification has not changed to date. Much of the literature has focused upon whether CABG or percutaneous coronary intervention (PCI) produces better outcomes; there is a paucity of data comparing the odds of receiving these procedures. A secondary analysis was conducted in a de-identified database comprised of 30,482 patients satisfying the entry criteria. Odds of occurrence (CABG, PCI) were determined as the binary dependent variable in period 1, (17 October 2009 through 31 December 2011), and period 2 (1 January 2013 through 16 March 2015), before and after the 2011 guidelines, while controlling for gender, ethnicity/race, and ischemic heart disease as covariates. The odds of performing CABG rather than PCI in period 2 were not statistically significantly different than in period 1 (p = 0.400). The logistic regression model chi-square statistic was statistically significant, with χ(2) (7) = 308.850, p < 0.0001. The Wald statistic showed that ethnicity/race (African American, Caucasian, Hispanic and Other), gender, and heart disease contributed significantly to the prediction model with p < 0.05, but ethnicity ‘Unknown’ did not. The odds of CABG versus PCI in period 2 were 0.98 times those in period 1 95% confidence interval (CI) = (0.925, 1.032), statistically controlling for covariates. There was no significant rise in the odds of undergoing a CABG among this dataset of high-risk patients with diabetes and multivessel coronary heart disease. Modern practice has evolved regarding patient choice and additional variables that impact the final revascularization method employed. The degree to which odds of occurrence of procedures are a reliable surrogate for provider compliance with guidelines remains uncertain.
format Online
Article
Text
id pubmed-6956319
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-69563192020-01-23 Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease Rumana, Umme Kones, Richard Taheer, Montather O. Elsayed, Mohamed Johnson, Craig W. J Cardiovasc Dev Dis Article In diabetes patients with chronic ≥3 vessel disease, coronary artery bypass grafting (CABG) holds a class I recommendation in the American College of Cardiology and American Heart Association (ACC/AHA) 2011 guidelines, and this classification has not changed to date. Much of the literature has focused upon whether CABG or percutaneous coronary intervention (PCI) produces better outcomes; there is a paucity of data comparing the odds of receiving these procedures. A secondary analysis was conducted in a de-identified database comprised of 30,482 patients satisfying the entry criteria. Odds of occurrence (CABG, PCI) were determined as the binary dependent variable in period 1, (17 October 2009 through 31 December 2011), and period 2 (1 January 2013 through 16 March 2015), before and after the 2011 guidelines, while controlling for gender, ethnicity/race, and ischemic heart disease as covariates. The odds of performing CABG rather than PCI in period 2 were not statistically significantly different than in period 1 (p = 0.400). The logistic regression model chi-square statistic was statistically significant, with χ(2) (7) = 308.850, p < 0.0001. The Wald statistic showed that ethnicity/race (African American, Caucasian, Hispanic and Other), gender, and heart disease contributed significantly to the prediction model with p < 0.05, but ethnicity ‘Unknown’ did not. The odds of CABG versus PCI in period 2 were 0.98 times those in period 1 95% confidence interval (CI) = (0.925, 1.032), statistically controlling for covariates. There was no significant rise in the odds of undergoing a CABG among this dataset of high-risk patients with diabetes and multivessel coronary heart disease. Modern practice has evolved regarding patient choice and additional variables that impact the final revascularization method employed. The degree to which odds of occurrence of procedures are a reliable surrogate for provider compliance with guidelines remains uncertain. MDPI 2019-11-18 /pmc/articles/PMC6956319/ /pubmed/31752091 http://dx.doi.org/10.3390/jcdd6040041 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rumana, Umme
Kones, Richard
Taheer, Montather O.
Elsayed, Mohamed
Johnson, Craig W.
Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease
title Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease
title_full Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease
title_fullStr Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease
title_full_unstemmed Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease
title_short Trends in Guideline-Driven Revascularization in Diabetic Patients with Multivessel Coronary Heart Disease
title_sort trends in guideline-driven revascularization in diabetic patients with multivessel coronary heart disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956319/
https://www.ncbi.nlm.nih.gov/pubmed/31752091
http://dx.doi.org/10.3390/jcdd6040041
work_keys_str_mv AT rumanaumme trendsinguidelinedrivenrevascularizationindiabeticpatientswithmultivesselcoronaryheartdisease
AT konesrichard trendsinguidelinedrivenrevascularizationindiabeticpatientswithmultivesselcoronaryheartdisease
AT taheermontathero trendsinguidelinedrivenrevascularizationindiabeticpatientswithmultivesselcoronaryheartdisease
AT elsayedmohamed trendsinguidelinedrivenrevascularizationindiabeticpatientswithmultivesselcoronaryheartdisease
AT johnsoncraigw trendsinguidelinedrivenrevascularizationindiabeticpatientswithmultivesselcoronaryheartdisease