Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Diabetic Patients With Multivessel and/or Left Main Coronary Artery Disease: A Meta-Analysis.
Kongyong CuiShuzheng LyuXiantao SongHong LiuFei YuanFeng XuMin ZhangWei WangMingduo ZhangDongfeng ZhangJinfan TianPublished in: Angiology (2019)
With the development of stent design and surgical techniques, the relative benefit of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and complex coronary artery disease are highly debated. This meta-analysis was conducted to compare the outcomes of drug-eluting stent (DES) implantation and CABG in these cohorts. A comprehensive search of PubMed, Embase, and Cochrane Library up to January 4, 2018, was performed. Only randomized controlled trials (RCTs), subgroup analysis from RCTs, or adjusted observational studies were eligible. Five RCTs and 13 adjusted observational studies involving 17 532 patients were included. Overall, PCI with DES was significantly associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.05-1.29), myocardial infarction (MI; HR: 1.69, 95% CI: 1.43-2.00), and repeat revascularization (HR: 3.77, 95% CI: 2.76-5.16) compared with CABG. Nevertheless, the risk of stroke was significantly lower in the DES group (HR: 0.67, 95% CI: 0.54-0.83). The incidence of the composite end point of death, MI, or stroke was comparable between the 2 groups (HR: 0.99, 95% CI: 0.84-1.17). Despite the higher risk of stroke, CABG was better than PCI with DES for diabetic patients with multivessel and/or left main coronary artery disease.
Keyphrases
- coronary artery bypass grafting
- coronary artery disease
- percutaneous coronary intervention
- atrial fibrillation
- st segment elevation myocardial infarction
- st elevation myocardial infarction
- acute myocardial infarction
- antiplatelet therapy
- cardiovascular events
- acute coronary syndrome
- systematic review
- ejection fraction
- type diabetes
- coronary artery bypass
- end stage renal disease
- heart failure
- newly diagnosed
- randomized controlled trial
- risk factors
- patient reported outcomes
- prognostic factors
- metabolic syndrome
- cardiovascular disease
- case control