Efficacy and safety of drug-eluting stenting compared with bypass grafting in diabetic patients with multivessel and/or left main coronary artery disease

Abstract

Although percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) and bypass grafting are generally believed to be superior revascularization strategies in patients with coronary artery disease (CAD), the optimal strategy for diabetic patients is still controversial. This meta-analysis was performed to compare two methods of revascularization for patients with diabetes mellitus with left main coronary artery lesions or disease in multiple coronary arteries. Compared with the coronary artery bypass grafting (CABG) group, those receiving PCI-DES showed a greater risk of major adverse cardiovascular events (MACEs) (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.01–1.25, P = 0.03), major adverse cardiac and cerebrovascular events (MACCEs) (HR: 1.85, 95% CI: 1.58–2.16; P < 0.001), stroke (HR: 1.15, 95% CI: 1.02–1.29, P = 0.02), myocardial infarction (MI) (HR: 1.48, 95% CI: 1.04–2.09, P = 0.03), and repeat revascularization (HR: 3.23, 95% CI: 1.37–7.59, P = 0.007). CABG for diabetic patients with multivessel and/or left main CAD was superior to PCI-DES with regard to MACEs, MACCEs, MI, repeat revascularization and stroke, but there was no clear difference in all-cause mortality.

Long term outcomes of percutaneous coronary intervention vs coronary artery bypass grafting in patients with diabetes mellitus with multi vessels diseases: A meta-analysis

“…Other studies comparing PCI and CABG in diabetics patients also revealed similar results as our meta-analysis in terms of all-cause mortality, MACCE, cardiac death, revascularization rate, MI development and CVA [48] , [49] , [50] . However, two previous meta-analyses showed all-cause mortality was not statistically significantly between both procedures in diabetic patients with multivessel or left main CAD [51] , [52] but had much lower sample size compared to our study. Nevertheless, these studies still revealed significant reduction in MACCE, cardiac death, MI and revascularization rate in patients undergoing CABG [51] , [52] .…”

“…However, two previous meta-analyses showed all-cause mortality was not statistically significantly between both procedures in diabetic patients with multivessel or left main CAD [51] , [52] but had much lower sample size compared to our study. Nevertheless, these studies still revealed significant reduction in MACCE, cardiac death, MI and revascularization rate in patients undergoing CABG [51] , [52] .…”

Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies

“…CABG is more invasive than PCI and has a higher risk of adverse cerebral vascular events during perioperative period [32]. Although PCI is more likely to be associated with higher rate of adverse events after revascularization, previous studies [13] have reported no difference in mortality between PCI and CABG and CABG was associated with excess stroke [33, 34], making it difficult for physicians to assess the two strategies. This study pooled data from 16 studies, which included 18,224 diabetic patients (follow-up ≥ 1 year) with left main CAD and/or MVD, undergoing either PCI or CABG.…”

“…Mahmoud et al [36] compared the clinical outcomes between these two strategies found that PCI was associated with a lower early risk of MACCE, while the risk of all-cause mortality, MI, and stroke were similar to CABG at long-term follow-up. Additionally, an in-depth comparative study of patients with DM [12] found that the risk of mortality (1–5 year follow-up) was not significantly different between PCI and CABG patients with DM; results that were supported by a recent study found no obvious difference in the incidence of all-cause mortality between the two strategies [13].…”

“…Recently, two meta-analyses based on several published studies (e.g., Dai et al [12]) found that the incidence of all-cause mortality (1–5 years follow-up) of DM patients underwent PCI did not differ significantly from those who underwent CABG. Similarly, Xin et al [13] found no clear difference in mortality between CABG and PCI in patients with DM and serious coronary disease. However, these analyses assessed a limited number of studies.…”