June 5, 2021Clinical CardiologyOpen Access

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta‐analysis

View Full Paper

Ask AI

Bookmark

Why the study?

Previous meta-analyses showed lower all-cause mortality with CABG compared to PCI for coronary heart disease, but long-term outcomes were not analyzed thoroughly in patients with type 2 diabetes mellitus.

Does percutaneous coronary intervention compared to coronary artery bypass grafting improve long-term outcomes in patients with coronary heart disease and type 2 diabetes mellitus?

Structured PICO

Does percutaneous coronary intervention compared to coronary artery bypass grafting improve long-term outcomes in patients with coronary heart disease and type 2 diabetes mellitus?

Population

4,566 patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) pooled from 9 RCTs

Intervention

Percutaneous coronary intervention (PCI)

Comparator

Coronary artery bypass grafting (CABG)

Outcome

All-cause deathhard clinical

In patients with coronary heart disease and type 2 diabetes, CABG provides superior long-term survival and freedom from repeat revascularization compared to PCI, though PCI is associated with a lower risk of stroke.

Implication

CABG preferred over PCI for long-term survival in T2DM with multivessel CHD; confirms prior meta-analyses with updated temporal trends.

Abstract

Previous meta-analyses showed that coronary artery bypass grafting (CABG) has lower all-cause mortality than percutaneous coronary intervention (PCI) for the management of coronary heart disease (CHD), but the long-term outcomes were not analyzed thoroughly in patients with type 2 diabetes mellitus (T2DM). To perform a meta-analysis of randomized controlled trials (RCTs) to explore the long-term effectiveness between CABG and PCI in patients with T2DM and study the temporal trends using a cumulative meta-analysis. PubMed, Embase, Cochrane library, and Clinical Trials Registry for eligible RCTs published up to September 2020. The outcomes were all-cause death, cardiac death, myocardial infarction, repeat revascularization, and stroke. Nine RCTs and 4566 patients were included. CABG resulted in better outcomes than PCI in terms of all-cause death (RR = 1.41, 95%CI: 1.22-1.63, p < 0.001), cardiac death (RR = 1.56, 95%CI: 1.25-1.95, p < 0.001), and repeat revascularization (RR = 2.68, 95%CI: 1.86-3.85, p < 0.001), but with difference regarding the occurrence of myocardial infarction (RR = 1.20, 95%CI: 0.78-1.85, p = 0.414), while PCI was associated with better outcomes in terms of stroke occurrence (RR = 0.51, 95%CI: 0.34-0.77, p = 0.001). The cumulative meta-analysis for all-cause death showed that the differences between CABG and PCI started to be significant at 3 years of follow-up, while the difference became significant at 5 years for cardiac death. In patients with CHD and T2DM, CABG results in better outcomes than PCI in terms of all-cause death, cardiac mortality, and repeat revascularization, while PCI had better outcomes in terms of stroke. The differences are mainly observed over the long-term follow-up.