Abstract 16673: Meta-Analysis of Three Randomized Controlled Trials Comparing Coronary Artery Bypass Grafting With Percutaneous Coronary Intervention Using Drug-Eluting Stenting in Patients With Diabetes
Background: Coronary Artery Bypass Grafting (CABG) was found to be the preferred strategy of revascularization in patients with diabetes in the bare metal stent (BMS) era . The introduction of Drug eluting stents (DES) led to a significant reduction in the rates of repeat revascularization, death and myocardial infarction in the contemporary era when compared to BMS. Multiple randomized controlled trials compared the impact of CABG vs. percutaneous coronary intervention using DES on patients with Diabetes. We did a collaborative analysis of data from randomized controlled trials in the contemporary era to compare the modalities in Patients Diabetes.
Methods: We did a systematic review and meta-analysis from randomized trials in the contemporary era comparing PCI with DES to CABG in diabetic patients .A comprehensive literature search (01/01/2003 to 05/18/2013) identified three randomized controlled trial that reported long-term outcomes comparing PCI using DES and CABG in diabetic patients. Data from these three trials that included 2854 patients were used to compare the outcomes at 1 and 5 years respectively.
Results: At 1 year PCI was associated with significant increase incidence in Target Vessel Revascularization (TVR) (12.84% vs. 4.70%; RR= 2.48 [1.56 - 3.94]; P=<0.0001), and MI (5.98%vs. 3.74%; RR= 1.5; 95% CI: [1.06 - 2.13]; P<0.0215), a lower incidence of stroke (0.75% vs. 1.99%; RR= 0.43 [1.56 - 3.94]; P=0.017), and no difference in death (4.51% vs. 4.23%; RR= 1.05; 95% CI: [0.75 - 1.48]; P= 0.7725). At 5 years PCI was still associated with lower incidence of stroke (0.75% vs. 1.99%; RR= 0.43; 95% CI: [0.21 - 0.86]; P=0.017), but with a significant increase incidence of death (13.56% vs. 9.96%; RR= 1.36 (1.11 - 1.66); P= 0.0033) and MI (10.64% vs. 5.30%; RR= 2.01 [1.54 - 2.62]; P=<0.0001).
Conclusion: Although PCI is not associated with a significant difference in incidence of death, it is associated with a significant increase in incidence of MI in patients with diabetes when compared to CABG at 1 year. At 5 years PCI is associated with higher incidence of both death and MI. PCI is associated with significantly higher incidence of TVR and lower incidence of stroke when compared with CABG.
- © 2013 by American Heart Association, Inc.