MedicalResearch.com Interview with:
Dr. Jayan Nagendran MD, PhD, FRCSC
Director of Research, Division of Cardiac Surgery
Associate Professor, Department of Surgery
Division of Cardiac Surgery
University of Alberta
MedicalResearch.com: What is the background for this study?
Response: The primary modalities of treatment of symptomatic coronary artery disease (coronary heart disease) are either percutaneous coronary intervention (coronary stunting) or coronary artery bypass grafting surgery. There are well designed clinical trials that guide clinical practice for the treatment of patients with diabetes requiring coronary revascularization and there are trials that examine the best modality of coronary revascularization in patients with left ventricular dysfunction. However, there is a lack of evidence for patients with both diabetes and left ventricular dysfunction. As such, we performed a propensity matched study of patients with diabetes and left ventricular dysfunction undergoing either percutaneous coronary intervention compared to coronary artery bypass grafting surgery. We used our provincial database that captures >100,000 patients undergoing coronary angiography to attain our two cohorts for comparison.
MedicalResearch.com: What are the main findings?
Response: The results of the study strongly suggest that coronary artery bypass grating surgery is a superior modality of revascularization for patients with diabetes and left ventricular dysfunction compared to percutaneous coronary intervention. There is a significant decrease in death, myocardial infarction (heart attack), and repeat revascularization in patients undergoing coronary artery bypass grafting surgery compared to percutaneous coronary intervention. Also, there was no significant difference in rates of strokes between the two groups.
MedicalResearch.com: What should readers take away from your report?
Response: Patients with diabetes and left ventricular dysfunction should be considered and likely referred for coronary artery bypass grafting surgery as the primary modality of therapy.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The difficulty in running and funding large surgical clinical trials is often prohibitive with regards to cost. Well designed propensity matched studies can allow for best evidence to be elucidated where clinical trials are not feasible. Further amalgamation of large data sets will allow further refinement to evidence guiding clinical practice, and will better predict personalized treatments with fidelity.
MedicalResearch.com: Is there anything else you would like to add?
Response: As there is a growing aging population and there is a significant increase in diabetes, resulting in an increased prevalence of coronary artery disease in society. This study helps guide clinicians toward the best practice for patients with diabetes and left ventricular dysfunction.
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