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Interact Cardiovasc Thorac Surg. 2014 Dec;19(6):1002-7. doi: 10.1093/icvts/ivu291. Epub 2014 Sep 3.

Meta-analysis of three randomized controlled trials comparing coronary artery bypass grafting with percutaneous coronary intervention using drug-eluting stenting in patients with diabetes.

Author information

1
Division of Cardiology, Christiana Care Health System, Newark, DE, USA zfanari@christianacare.org.
2
Division of Cardiology, Christiana Care Health System, Newark, DE, USA.
3
Value Institute, Christiana Care Health System, Newark, DE, USA.
4
Division of Cardiology, Christiana Care Health System, Newark, DE, USA Value Institute, Christiana Care Health System, Newark, DE, USA.

Abstract

OBJECTIVES:

Coronary artery bypass grafting (CABG) was found to be the preferred strategy of revascularization in patients with diabetes in the bare-metal stent (BMS) era. The introduction of drug-eluting stents (DESs) led to a significant reduction in the rates of repeat revascularization (RRV) when compared with BMSs. We did a collaborative analysis of data from randomized controlled trials in the contemporary era to compare CABG versus percutaneous coronary intervention using DESs in diabetic patients.

METHODS:

We performed a systematic review and meta-analysis from randomized trials in the contemporary era comparing PCI with DESs with CABG in diabetic patients with multivessel disease. A comprehensive literature search (1 January 2003 to 18 May 2013) identified randomized controlled trials that reported long-term outcomes comparing PCI using DESs with CABG in 2974 diabetic patients.

RESULTS:

At 1 year, PCI was associated with a significant increase in the incidence of RRV [2.48 (1.56-3.94); P ≤0.0001], lower incidence of stroke [relative risk (RR) = 0.43 (0.19-0.81); P = 0.017], and no difference in death or myocardial infarction (MI). At 5 years, PCI was still associated with a lower incidence of stroke, but was associated with a significant increase in the incidence of death [RR = 1.36 (1.11-1.66); P = 0.0033] and MI [RR = 2.01 (1.54-2.62); P ≤0.0001].

CONCLUSIONS:

In patients with diabetes, PCI was associated with no difference in death and MI at 1 year. However, at 5 years, PCI was associated with a higher incidence of death and MI. PCI was associated with a higher incidence of RRV but a lower incidence of stroke.

KEYWORDS:

Coronary artery bypass grafting; Death; Diabetes; Drug-eluting stents; Myocardial infarction; Percutaneous coronary intervention; Randomized control trials; Repeat revascularization; Stroke

PMID:
25185569
DOI:
10.1093/icvts/ivu291
[Indexed for MEDLINE]

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