All arterial versus non-total arterial coronary artery bypass grafting in diabetic patients: A systematic review and meta-analysis

Background: In this meta-analysis, we compare total arterial revascularization versus non-total arterial revascularization coronary artery bypass grafting in diabetic patients and discuss long-term survival rate and early mortality rate, cerebrovascular accident, myocardial infarction, sternal wound infection. Methods: We searched the Cochrane Library, PubMed, Thieme-Connect and Sage Pub databases for studies which were published from January 2003 to October 2023. Observational studies with propensity-score matched analysis comparing total arterial revascularization versus non-total arterial revascularization coronary artery bypass grafting in diabetic patients were included. The risk of bias was analyzed. Fixed-effects model and random-effects meta-analysis with leave-one-out method as sensitivity analysis were performed. Results: Six observational studies which were published involving a total of 15,336 patients were included in the meta-analysis. There were significant differences in the long-term survival rates and early myocardial infarction. Total arterial revascularization had higher survival rate (incidence rate ratio [IRR]=0.85, 95% confidence interval [CI]: 0.74-0.98, p=0.02) and lower myocardial infarction event than non-total arterial revascularization (odds ratio [OR]=0.45, 95% CI: 0.22-0.92, p=0.03). Conclusion: Total arterial revascularization is significantly associated with higher survival rate and lower early myocardial infarction than non-total arterial revascularization in diabetic patients undergoing coronary artery bypass grafting.