Coronary revascularization in diabetic patients: a systematic review and Bayesian network meta-analysis.
BACKGROUND
The optimal revascularization technique in diabetic patients is an important unresolved question.


OBJECTIVE
To compare long-term outcomes between the revascularization techniques of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).


METHODS
English-language publications in PubMed, the Cochrane Central Register of Controlled Trials, Ovid, and EMBASE between 1 January 1990 and 1 June 2014.


METHODS
Two investigators independently reviewed randomized, controlled trials comparing PCI (with drug-eluting or bare-metal stents) with CABG in adults with diabetes with multivessel or left main coronary artery disease.


METHODS
Study design, quality, patient characteristics, length of follow-up, and outcomes were extracted. For duplicate publications, outcomes were obtained from the publication with the longest follow-up.


RESULTS
40 studies were combined using a Bayesian network meta-analysis that accounted for the variation in stent choice. The primary outcome, a composite of all-cause mortality, nonfatal myocardial infarction, and stroke, increased with PCI (odds ratio [OR], 1.33 [95% credible interval {CrI}, 1.01 to 1.65]). Percutaneous coronary intervention resulted in increased mortality (OR, 1.44 [CrI, 1.05 to 1.91]), no change in the number of myocardial infarctions (OR, 1.33 [CrI, 0.86 to 1.95]), and fewer strokes (OR, 0.56 [CrI, 0.36 to 0.88]).


CONCLUSIONS
Study design and length of follow-up were heterogeneous, and results were driven primarily by a single study. Costs and nonvascular complications of the interventions were not examined.


CONCLUSIONS
Coronary artery bypass grafting seems to be the preferred revascularization technique in diabetics, especially if long-term survival is anticipated. However, because of residual uncertainties and increased risk for stroke with CABG, clinical judgment is required when choosing a revascularization technique in patients with diabetes.


BACKGROUND
Fonds de recherche du Québec-Santé.
Benny
B
Tu
Ben
B
Rich
Christopher
C
Labos
James M
JM
Brophy
D001499:Bayes Theorem; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D048909:Diabetes Complications / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D009026:Mortality; D062645:Percutaneous Coronary Intervention; D015607:Stents