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.
Highlights
To date, a number of clinical trials have compared percutaneous coronary intervention (PCI)-drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with Diabetes mellitus (DM) and multivessel or left main coronary artery disease[11,12,13,14,15,16,17,18]
The sensitivity analysis via a random effects model indicated that the superiority of CABG over PCI was clear, with no statistically significant difference compared with the results of the fixed effects meta-analysis (Table 2)
The first data provided by the APPROACH trial showed that the diabetic population with coronary artery disease (CAD) and left ventricular dysfunction (LVD) benefit from CABG rather than PCI-DES, with an elevated long-term overall survival and reduced prevalence rates of repeat revascularization and myocardial infarction (MI); no clear difference was found with respect to stroke among the included diabetic patients
Summary
A number of clinical trials have compared PCI-DES and CABG in patients with DM and multivessel or left main coronary artery disease[11,12,13,14,15,16,17,18]. There is not powerful evidence to find statistically significant differences with respect to all-cause mortality, major adverse cardiovascular events (MACEs), major adverse cardiac and cerebrovascular events (MACCEs), stroke, repeat revascularization and myocardial infarction (MI) between the PCI and CABG groups. Considering this situation, it is imperative to conduct a quantitative evaluation and synthesis of the current information about the optimal revascularization strategy for these patients
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