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Coronary Revascularization in Patients With Diabetes: A Meta-Analysis of Randomized Controlled Trials and
Adham Ahmed1, Kathryn S Varghese1, Peter J Fusco1
1City University of New York School of Medicine, New York, NY, USA.
Insights
Coronary artery bypass grafting (CABG) shows better long-term outcomes than percutaneous coronary intervention (PCI) for patients with diabetes and coronary artery disease (CAD). CABG reduces mortality, myocardial infarction, and repeat revascularization compared to PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetology
Background:
- Patients with diabetes mellitus often experience poorer outcomes with coronary artery disease (CAD).
- Revascularization strategies for diabetic patients with CAD require careful consideration due to unique clinical challenges.
Approach:
- A pairwise meta-analysis was conducted on randomized controlled trials (RCTs) and propensity-matched observational studies (PMS).
- The analysis compared coronary artery bypass grafting (CABG) against percutaneous coronary intervention (PCI) in diabetic patients with concurrent CAD.
- Primary outcomes included mortality, myocardial infarction (MI), major adverse cardiac and cerebrovascular events (MACCE), and repeat revascularization.
Key Points:
- PCI was associated with significantly higher long-term all-cause mortality, cardiac mortality, MI, MACCE, and repeat revascularization compared to CABG.
- No significant difference in long-term stroke rates was observed between PCI and CABG.
- Meta-regression indicated that a higher proportion of female patients in studies correlated with reduced CABG benefit for mortality but increased benefit for MI and repeat revascularization.
Conclusions:
- Coronary artery bypass grafting (CABG) demonstrates superior long-term clinical outcomes, including reduced mortality and repeat revascularization, for diabetic patients with CAD compared to percutaneous coronary intervention (PCI).
- Further research is warranted to investigate the influence of gender on revascularization outcomes in this patient population.
Objective:
Patients with diabetes have poorer outcomes with coronary artery disease (CAD) and pose a unique clinical population for revascularization. We performed a pairwise meta-analysis of randomized trials (RCTs) and propensity-matched observational studies (PMS) to compare the clinical outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with diabetes.
Methods:
A comprehensive literature search was performed to identify RCT and PMS studies comparing CABG with PCI in patients with diabetes with concurrent CAD. Studies were pooled using the random-effects model to perform a pairwise meta-analysis. Primary outcomes included long-term all-cause mortality, cardiac mortality, myocardial infarction (MI), major adverse cardiac and cerebrovascular events (MACCE), and repeat revascularization. Meta-regression was used to explore the effects of baseline risk factors on primary outcomes with moderate to high heterogeneity.
Results:
A total of 18 RCTs and 9 PMS with 28,846 patients were included. PCI was associated with increased long-term all-cause mortality (risk ratio [RR] = 1.34, P < 0.001), cardiac mortality (RR = 1.52, P < 0.001), MI (RR = 1.51, P = 0.009), MACCE (RR = 1.65, P < 0.001), and repeat revascularization (RR = 2.48, P < 0.001) compared with CABG. There was no difference in long-term stroke between the 2 groups (RR = 0.95, P = 0.82). At meta-regression, a greater proportion of female patients in studies was associated with a decreased protective benefit for CABG for long-term all-cause mortality but an increased protective benefit for long-term MI and repeat revascularization.
Conclusions:
Revascularization of patients with diabetes using CABG is associated with significantly reduced long-term mortality, MI, MACCE, and repeat revascularizations. Future studies exploring the influence of gender on revascularization outcomes are necessary to elucidate the ideal treatment modality in patients with diabetes.
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