Abstract 15149: Aggregate Bayesian Meta-Analysis of Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients With Diabetes
Background: The recent results from the FREEDOM trial indicate the superiority of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with multivessel disease and diabetes. However, previous studies examining this population did not find significant differences with respect to composite endpoints of death, myocardial infarction or stroke. We sought to examine the impact of this difference by conducting a Bayesian meta-analysis of randomized control trials investigating PCI versus CABG in patients with diabetes and multivessel disease.
Methods: A literature search was performed and identified 3 RCTs with patients with diabetes and CAD randomized to CABG or PCI with DES. Major endpoints evaluated were the combination of death from any cause, non-fatal stroke, and myocardial infarction. Using this data, an aggregate, sequential Bayesian meta-analysis was performed, and probabilities of benefit, along with magnitude of therapeutic effect, were calculated.
Results: Posterior probabilities for the combined endpoint of stroke, myocardial infarction and all cause mortality indicate a 90.3% probability of benefit for CABG over PCI, driven primarily by results from the FREEDOM trial. However, magnitude of therapeutic effect analysis shows a probability of benefit of greater than 10% odds ratio benefit of 63.8%, where 50% is equivocal.
Conclusions: The results of the Bayesian meta-analysis of PCI versus CABG in patients with diabetes and multivessel CAD suggest overall benefit to the use of CABG in this patient population in terms of the combined endpoint of mortality, MI and stroke. However, the results of previous trials temper the magnitude of benefit illustrated in the FREEDOM trial. This supports the notion that PCI remains a viable alternative to CABG, and should prompt balanced treatment discussions in patients with diabetes found to have multivessel coronary disease.
- © 2013 by American Heart Association, Inc.