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In Diabetics with Ischemic Heart Disease CABG revascularization is always superior ?

In Diabetics with Ischemic Heart Disease CABG revascularization is always superior ?. Dr. Paolo Ferrazzi. CLINICAL SCENARIO. DN, male , 65 yr NIDDM , HT BMI 28 3 vessel disease. What is the best OPTION?. Background. M ajor developments in CABG

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In Diabetics with Ischemic Heart Disease CABG revascularization is always superior ?

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  1. In Diabetics with IschemicHeartDisease CABG revascularizationisalwayssuperior? Dr. Paolo Ferrazzi

  2. CLINICAL SCENARIO DN, male, 65 yr NIDDM, HT BMI 28 3 vessel disease Whatis the best OPTION?

  3. Background • Major developments in CABG • off-pump technique, less invasive approach, increased arterial revascularization and optimal perioperative care • Major developments in PCI • improved technique, stent design, guide wires, anti-platelet therapy, and drug-eluting stents • Important to reassess the respective values of the two revascularization

  4. 7812 patients • Median FU 6 years • 65%: 1 or 2 VD; allnormal LV • 1233 with DM • HR for CABG vs PCI in DM 0.70; p= 0.01 • Survival benefit of CABG increases with time Lancet 2009; 373: 1190–97

  5. p<0,001 p=0,38 p=0,078

  6. FREEDOM TRIAL:PATIENTS WITH DIABETES New England J. of Medicine, December 20, 2012; Vol. 367 No. 25

  7. Survival benefit with two IMA grafts?

  8. Bergamo experience 2012Diabetic and non DiabeticPatients

  9. Bergamo experienceSurgicaloptionsin diabetes LIMA Pedicled + RIMA skeletonizedin situ LIMA + RIMA skeletonizedin situ LIMA in situ + RIMA (Y grafted)

  10. p<0.001 P=0.006 Compared with SIMA grafting, BIMA grafting in propensity score–matched patients provides diabetics with enhanced survival without any increase in perioperative morbidity or mortality Actuarial survival unmatched diabetic pts <65yr Actuarial survival unmatched diabetic pts p<0.001 P=0.014 Actuarialsurvivalpropensity score–matched diabetic pts Actuarial survival unmatched diabetic pts ≥65yr

  11. Conclusions • CABG seems to have better long-term results in complex multivessel diabetic patients • Two mammary seems to be better than one • Adding radial artery to revascularization strategy could further improve results The optimum revascularization strategy for each individual patient will depend on a careful consideration of the risks and benefits of each procedure in conjunction with the baseline riskprofile

  12. PCI CABG

  13. SYNTAX Trial: top 15 Enrollers

  14. P<0.001 P=0.001

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