Abstract 9448: The Effect of Diabetes on Cardiovascular Events After Coronary Artery Bypass Grafting versus Drug-Eluting Stents for Left Main Coronary Artery Disease: A Meta-Analysis

Abstract

Background: The optimal method of coronary revascularization for diabetes mellitus (DM) patients with left main coronary artery disease (LMCAD) is controversial in the drug-eluting stent (DES) era. We performed a systematic review and meta-analysis comparing DES-based percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) for LMCAD in DM patients and tested for potential effect measure modification (EMM) by diabetes on major adverse cardiovascular and cerebrovascular events (MACCE). Methods and Results: We included all randomized controlled trials (RCTs) and observational studies comparing CABG to DES-based PCI including DM patients with LMCAD published up to March 1, 2021. We completed separate random-effects meta-analyses for four RCTs (4,356 patients, mean follow-up of 4.9 years) and six observational studies (9,360 patients, mean follow-up of 5.2 years). DM and non-DM patients were at increased risk of the composite endpoint of all-cause mortality, myocardial infarction, stroke, and unplanned revascularization when comparing CABG to DES-based PCI (p-value for interaction = 0.70) (Figure 1, DM =1, Non-DM =0). In observational studies, there was no difference between DES-based PCI and CABG for all-cause mortality in patients with DM (Figure 2). Conclusion: DES-based PCI was associated with an increased risk of MACCE compared to CABG in LMCAD patients irrespectively of DM status. We did not observe significant EMM by DM status. Considering these data, heart teams could consider DM as one of the many components in the clinical decision-making process, but not as a primary deciding factor between DES and CABG for LMCAD.