Optimal revascularization in diabetes after the FREEDOM trial: Were the controversies finally settled?

Tenenbaum, Alexander; Fisman, Enrique Z.

doi:10.5603/cj.2013.0090

Cited by 1 publication

(1 citation statement)

References 38 publications

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“…Finally, similar to the FREEDOM trial which clearly showed revascularization by CABG to be superior compared to PCI in patients with T2DM, our study which also showed CABG to be better than PCI in patients with ITDM, also suggests a comparative analysis of the new incoming stents which warrant further research [ 31 ].…”

Section: Discussionsupporting

confidence: 74%

Coronary artery bypass surgery compared with percutaneous coronary interventions in patients with insulin-treated type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials

Bundhun

Chen

2016

Cardiovasc Diabetol

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BackgroundData regarding the long-term clinical outcomes in patients with insulin-treated type 2 diabetes mellitus (ITDM) revascularized by either coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) are still controversial. We sought to compare the long-term (≥1 year) adverse clinical outcomes in patients with ITDM who underwent revascularization by either CABG or PCI.MethodsRandomized Controlled Trials (RCTs) comparing the long-term clinical outcomes in patients with ITDM and non-ITDM revascularized by either CABG or PCI were searched from electronic databases. Data for patients with ITDM were carefully retrieved. Odd Ratio (OR) with 95 % confidence interval (CI) was used to express the pooled effect on discontinuous variables and the pooled analyses were performed with RevMan 5.3.ResultsSix RCTs involving 10 studies, with a total of 1297 patients with ITDM were analyzed (639 patients from the CABG group and 658 patients from the PCI group). CABG was associated with a significantly lower mortality rate compared to PCI with OR: 0.59, 95 % CI 0.42–0.85; P = 0.004. Major adverse cardiovascular and cerebrovascular events as well as repeated revascularization were also significantly lower in the CABG group with OR: 0.51, 95 % CI 0.27–0.99; P = 0.03 and OR 0.34, 95 % CI 0.24–0.49; P < 0.00001 respectively. However, compared to PCI, the rate of stroke was higher in the CABG group with OR: 1.41, 95 % CI 0.64–3.09; P = 0.40, but this result was not statistically significant.ConclusionCABG was associated with significantly lower long-term adverse clinical outcomes compared to PCI in patients with ITDM. However, due to an insignificantly higher rate of stroke in the CABG group, further researches with a larger number of randomized patients are required to completely solve this issue.

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Section: Discussionsupporting

confidence: 74%