title: Meta-analysis of three randomized controlled trials comparing coronary artery bypass grafting with percutaneous coronary intervention using drug-eluting stenting in patients with diabetes.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, DE, USA zfanari@christianacare.org.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Fanari
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, DE, USA.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Weiss
authors.affiliation: Value Institute, Christiana Care Health System, Newark, DE, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Value Institute, Christiana Care Health System, Newark, DE, USA.
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, DE, USA Value Institute, Christiana Care Health System, Newark, DE, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Death; Diabetes; Drug-eluting stents; Myocardial infarction; Percutaneous coronary intervention; Randomized control trials; Repeat revascularization; Stroke