Drug-eluting stents versus coronary artery bypass grafting in diabetic patients with multi-vessel disease: a meta-analysis.
BACKGROUND
Data comparing long-term results after percutaneous intervention with drug-eluting stents (DES/PCI) and coronary artery grafting (CABG) in diabetic patients (pts) with multi-vessel disease is conflicting. We have conducted a systematic review and meta-analysis to help answer this issue.


METHODS
MEDLINE, WoS, and Scopus were systematically analysed to yield observational studies (OBS) or randomised controlled trials (RCT) fulfilling search criteria. Odds ratio (OR) for studied end-points were obtained with inverse variance random effects analysis. Results are presented with 95% confidence intervals with significance at p<0.05.


RESULTS
A total of 14 studies (5 RCT; 9 OBS) including more than 5000 pts were selected for review. Early/30-day was lower in the DES/PCI cohort [OR 0.49(0.27, 0.88); p=0.02; I(2)=0%]. Post-procedural stroke was higher in the CABG (1.8%) cohort compared to DES/PCI (0.17%; p<0.01). A pooled analysis of RCT demonstrated that stroke rate was similar in both cohorts at the end of one year [OR 0.84(0.19, 3.74); p=0.82; I(2) =67%]. During a follow-up of three to five years, repeat intervention was much higher in the DES/PCI cohort [OR 3.02(2.13, 4.28; p<0.01]. The odds of suffering an adverse cardiovascular /cerebrovascular event were 1.71 (1.27, 2.3) times higher in the DES/PCI cohort compared to CABG.


CONCLUSIONS
In diabetic patients with multivessel disease, early mortality is lower in the DES/PCI cohort. While peri-procedural stroke rates are lower with PCI, they are, however, comparable at the end of one year. Use of drug-eluting stents leads to a higher rate of re-intervention and major cardiovascular/cerebrovascular events at three to five years.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester.
Ju Yong
JY
Lim
Division of Cardiovascular Surgery, Mayo Clinic, Rochester; Department of Cardiac Surgery, Adventist Wockhardt Heart Hospital, Surat Gujarat. Electronic address: salildeo@yahoo.co.in.
Salil V
SV
Deo
Division of Cardiovascular Surgery, Mayo Clinic, Rochester; Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Wook Sung
WS
Kim
Department of Cardiac Surgery, Queen Alia Heart Institute, Amman Jordan.
Salah E
SE
Altarabsheh
Mayo Clinic Libraries, Rochester MN.
Patricia J
PJ
Erwin
Division of Cardiovascular Surgery, Case Medical Center, Case Western Reserve University, Cleveland OH.
Soon J
SJ
Park
D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass; D003925:Diabetic Angiopathies / Q000401:mortality / Q000601:surgery; D058065:Diabetic Cardiomyopathies / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery; D015996:Survival Rate
Coronary artery bypass grafting; Diabetes mellitus; Major adverse cardiovascular and cerebrovascular events; Myocardial infarction; Percutaneous intervention; Re-intervention