Effectiveness of percutaneous coronary intervention with drug-eluting stents compared with bypass surgery in diabetics with multivessel coronary disease

comprehensive systematic review and meta-analysis of randomized clinical data.

Abdul Hakeem, Nadish Garg, Sabha Bhatti, Naveen Rajpurohit, Zubair Ahmed, Barry F. Uretsky

Research output: Contribution to journalReview article

58 Citations (Scopus)

Abstract

Controversy persists regarding the optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD). Coronary artery bypass grafting (CABG) has been compared with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in recent randomized controlled trials (RCTs). RCTs comparing PCI with DES versus CABG in diabetic patients with MVD who met inclusion criteria were analyzed (protocol registration No. CRD42013003693). Primary end point (major adverse cardiac events) was a composite of death, myocardial infarction, and stroke at a mean follow-up of 4 years. Analyses were performed for each outcome by using risk ratio (RR) by fixed- and random-effects models. Four RCTS with 3052 patients met inclusion criteria (1539 PCI versus 1513 CABG). Incidence of major adverse cardiac events was 22.5% for PCI and 16.8% for CABG (RR 1.34, 95% CI 1.16 to 1.54, P<0.0001). Similar results were obtained for death (14% versus 9.7%, RR 1.51, 95% CI 1.09 to 2.10, P=0.01), and MI (10.3% versus 5.9%, RR 1.44, 95% CI 0.79 to 2.6, P=0.23). Stroke risk was significantly lower with DES (2.3% versus 3.8%, RR 0.59, 95% CI 0.39 to 0.90, P=0.01) and subsequent revascularization was several-fold higher (17.4% versus 8.0%, RR 1.85, 95% CI 1.0 to 3.40, P=0.05). These data demonstrate that CABG in diabetic patients with MVD at low to intermediate surgical risk (defined as EUROSCORE <5) is superior to MVD PCI with DES. CABG decreased overall death, nonfatal myocardial infarction, and repeat revascularization at the expense of an increase in stroke risk.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume2
Issue number4
DOIs
StatePublished - Jan 1 2013

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Drug-Eluting Stents
Percutaneous Coronary Intervention
Coronary Artery Bypass
Coronary Disease
Meta-Analysis
Odds Ratio
Stroke
Randomized Controlled Trials
Myocardial Infarction
Coronary Artery Disease
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Effectiveness of percutaneous coronary intervention with drug-eluting stents compared with bypass surgery in diabetics with multivessel coronary disease : comprehensive systematic review and meta-analysis of randomized clinical data. / Hakeem, Abdul; Garg, Nadish; Bhatti, Sabha; Rajpurohit, Naveen; Ahmed, Zubair; Uretsky, Barry F.

In: Journal of the American Heart Association, Vol. 2, No. 4, 01.01.2013.

Research output: Contribution to journalReview article

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title = "Effectiveness of percutaneous coronary intervention with drug-eluting stents compared with bypass surgery in diabetics with multivessel coronary disease: comprehensive systematic review and meta-analysis of randomized clinical data.",
abstract = "Controversy persists regarding the optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD). Coronary artery bypass grafting (CABG) has been compared with percutaneous coronary intervention (PCI) using drug-eluting stents (DES) in recent randomized controlled trials (RCTs). RCTs comparing PCI with DES versus CABG in diabetic patients with MVD who met inclusion criteria were analyzed (protocol registration No. CRD42013003693). Primary end point (major adverse cardiac events) was a composite of death, myocardial infarction, and stroke at a mean follow-up of 4 years. Analyses were performed for each outcome by using risk ratio (RR) by fixed- and random-effects models. Four RCTS with 3052 patients met inclusion criteria (1539 PCI versus 1513 CABG). Incidence of major adverse cardiac events was 22.5{\%} for PCI and 16.8{\%} for CABG (RR 1.34, 95{\%} CI 1.16 to 1.54, P<0.0001). Similar results were obtained for death (14{\%} versus 9.7{\%}, RR 1.51, 95{\%} CI 1.09 to 2.10, P=0.01), and MI (10.3{\%} versus 5.9{\%}, RR 1.44, 95{\%} CI 0.79 to 2.6, P=0.23). Stroke risk was significantly lower with DES (2.3{\%} versus 3.8{\%}, RR 0.59, 95{\%} CI 0.39 to 0.90, P=0.01) and subsequent revascularization was several-fold higher (17.4{\%} versus 8.0{\%}, RR 1.85, 95{\%} CI 1.0 to 3.40, P=0.05). These data demonstrate that CABG in diabetic patients with MVD at low to intermediate surgical risk (defined as EUROSCORE <5) is superior to MVD PCI with DES. CABG decreased overall death, nonfatal myocardial infarction, and repeat revascularization at the expense of an increase in stroke risk.",
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AU - Ahmed, Zubair

AU - Uretsky, Barry F.

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