Drug-eluting stents versus coronary artery bypass grafting in diabetic patients with multi-vessel disease: A meta-analysis

Ju Yong Lim, Salil V. Deo, Wook Sung Kim, Salah E. Altarabsheh, Patricia J. Erwin, Soon J. Park

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Data comparing long-term results after percutaneous intervention with drug-eluting stents (DES/PCI) and coronary artery grafting (CABG) in diabetic patients (pts) with multi-vessel disease is conflicting. We have conducted a systematic review and meta-analysis to help answer this issue. Methods: MEDLINE, WoS, and Scopus were systematically analysed to yield observational studies (OBS) or randomised controlled trials (RCT) fulfilling search criteria. Odds ratio (OR) for studied end-points were obtained with inverse variance random effects analysis. Results are presented with 95% confidence intervals with significance at p<0.05. Results: A total of 14 studies (5 RCT; 9 OBS) including more than 5000 pts were selected for review. Early/30-day was lower in the DES/PCI cohort [OR 0.49(0.27, 0.88); p=0.02; I2=0%]. Post-procedural stroke was higher in the CABG (1.8%) cohort compared to DES/PCI (0.17%; p<0.01). A pooled analysis of RCT demonstrated that stroke rate was similar in both cohorts at the end of one year [OR 0.84(0.19, 3.74); p=0.82; I2 =67%].During a follow-up of three to five years, repeat intervention was much higher in the DES/PCI cohort [OR 3.02(2.13, 4.28; p<0.01]. The odds of suffering an adverse cardiovascular /cerebrovascular event were 1.71 (1.27, 2.3) times higher in the DES/PCI cohort compared to CABG. Conclusion: In diabetic patients with multivessel disease, early mortality is lower in the DES/PCI cohort. While peri-procedural stroke rates are lower with PCI, they are, however, comparable at the end of one year. Use of drug-eluting stents leads to a higher rate of re-intervention and major cardiovascular/cerebrovascular events at three to five years.

Original languageEnglish (US)
Pages (from-to)717-725
Number of pages9
JournalHeart Lung and Circulation
Volume23
Issue number8
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Drug-Eluting Stents
Coronary Artery Bypass
Meta-Analysis
Odds Ratio
Randomized Controlled Trials
Stroke
Observational Studies
MEDLINE
Coronary Vessels
Confidence Intervals
Mortality

Keywords

  • Coronary artery bypass grafting
  • Diabetes mellitus
  • Major adverse cardiovascular and cerebrovascular events
  • Myocardial infarction
  • Percutaneous intervention
  • Re-intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Drug-eluting stents versus coronary artery bypass grafting in diabetic patients with multi-vessel disease : A meta-analysis. / Lim, Ju Yong; Deo, Salil V.; Kim, Wook Sung; Altarabsheh, Salah E.; Erwin, Patricia J.; Park, Soon J.

In: Heart Lung and Circulation, Vol. 23, No. 8, 2014, p. 717-725.

Research output: Contribution to journalArticle

Lim, Ju Yong ; Deo, Salil V. ; Kim, Wook Sung ; Altarabsheh, Salah E. ; Erwin, Patricia J. ; Park, Soon J. / Drug-eluting stents versus coronary artery bypass grafting in diabetic patients with multi-vessel disease : A meta-analysis. In: Heart Lung and Circulation. 2014 ; Vol. 23, No. 8. pp. 717-725.
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abstract = "Background: Data comparing long-term results after percutaneous intervention with drug-eluting stents (DES/PCI) and coronary artery grafting (CABG) in diabetic patients (pts) with multi-vessel disease is conflicting. We have conducted a systematic review and meta-analysis to help answer this issue. Methods: MEDLINE, WoS, and Scopus were systematically analysed to yield observational studies (OBS) or randomised controlled trials (RCT) fulfilling search criteria. Odds ratio (OR) for studied end-points were obtained with inverse variance random effects analysis. Results are presented with 95{\%} confidence intervals with significance at p<0.05. Results: A total of 14 studies (5 RCT; 9 OBS) including more than 5000 pts were selected for review. Early/30-day was lower in the DES/PCI cohort [OR 0.49(0.27, 0.88); p=0.02; I2=0{\%}]. Post-procedural stroke was higher in the CABG (1.8{\%}) cohort compared to DES/PCI (0.17{\%}; p<0.01). A pooled analysis of RCT demonstrated that stroke rate was similar in both cohorts at the end of one year [OR 0.84(0.19, 3.74); p=0.82; I2 =67{\%}].During a follow-up of three to five years, repeat intervention was much higher in the DES/PCI cohort [OR 3.02(2.13, 4.28; p<0.01]. The odds of suffering an adverse cardiovascular /cerebrovascular event were 1.71 (1.27, 2.3) times higher in the DES/PCI cohort compared to CABG. Conclusion: In diabetic patients with multivessel disease, early mortality is lower in the DES/PCI cohort. While peri-procedural stroke rates are lower with PCI, they are, however, comparable at the end of one year. Use of drug-eluting stents leads to a higher rate of re-intervention and major cardiovascular/cerebrovascular events at three to five years.",
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T2 - A meta-analysis

AU - Lim, Ju Yong

AU - Deo, Salil V.

AU - Kim, Wook Sung

AU - Altarabsheh, Salah E.

AU - Erwin, Patricia J.

AU - Park, Soon J.

PY - 2014

Y1 - 2014

N2 - Background: Data comparing long-term results after percutaneous intervention with drug-eluting stents (DES/PCI) and coronary artery grafting (CABG) in diabetic patients (pts) with multi-vessel disease is conflicting. We have conducted a systematic review and meta-analysis to help answer this issue. Methods: MEDLINE, WoS, and Scopus were systematically analysed to yield observational studies (OBS) or randomised controlled trials (RCT) fulfilling search criteria. Odds ratio (OR) for studied end-points were obtained with inverse variance random effects analysis. Results are presented with 95% confidence intervals with significance at p<0.05. Results: A total of 14 studies (5 RCT; 9 OBS) including more than 5000 pts were selected for review. Early/30-day was lower in the DES/PCI cohort [OR 0.49(0.27, 0.88); p=0.02; I2=0%]. Post-procedural stroke was higher in the CABG (1.8%) cohort compared to DES/PCI (0.17%; p<0.01). A pooled analysis of RCT demonstrated that stroke rate was similar in both cohorts at the end of one year [OR 0.84(0.19, 3.74); p=0.82; I2 =67%].During a follow-up of three to five years, repeat intervention was much higher in the DES/PCI cohort [OR 3.02(2.13, 4.28; p<0.01]. The odds of suffering an adverse cardiovascular /cerebrovascular event were 1.71 (1.27, 2.3) times higher in the DES/PCI cohort compared to CABG. Conclusion: In diabetic patients with multivessel disease, early mortality is lower in the DES/PCI cohort. While peri-procedural stroke rates are lower with PCI, they are, however, comparable at the end of one year. Use of drug-eluting stents leads to a higher rate of re-intervention and major cardiovascular/cerebrovascular events at three to five years.

AB - Background: Data comparing long-term results after percutaneous intervention with drug-eluting stents (DES/PCI) and coronary artery grafting (CABG) in diabetic patients (pts) with multi-vessel disease is conflicting. We have conducted a systematic review and meta-analysis to help answer this issue. Methods: MEDLINE, WoS, and Scopus were systematically analysed to yield observational studies (OBS) or randomised controlled trials (RCT) fulfilling search criteria. Odds ratio (OR) for studied end-points were obtained with inverse variance random effects analysis. Results are presented with 95% confidence intervals with significance at p<0.05. Results: A total of 14 studies (5 RCT; 9 OBS) including more than 5000 pts were selected for review. Early/30-day was lower in the DES/PCI cohort [OR 0.49(0.27, 0.88); p=0.02; I2=0%]. Post-procedural stroke was higher in the CABG (1.8%) cohort compared to DES/PCI (0.17%; p<0.01). A pooled analysis of RCT demonstrated that stroke rate was similar in both cohorts at the end of one year [OR 0.84(0.19, 3.74); p=0.82; I2 =67%].During a follow-up of three to five years, repeat intervention was much higher in the DES/PCI cohort [OR 3.02(2.13, 4.28; p<0.01]. The odds of suffering an adverse cardiovascular /cerebrovascular event were 1.71 (1.27, 2.3) times higher in the DES/PCI cohort compared to CABG. Conclusion: In diabetic patients with multivessel disease, early mortality is lower in the DES/PCI cohort. While peri-procedural stroke rates are lower with PCI, they are, however, comparable at the end of one year. Use of drug-eluting stents leads to a higher rate of re-intervention and major cardiovascular/cerebrovascular events at three to five years.

KW - Coronary artery bypass grafting

KW - Diabetes mellitus

KW - Major adverse cardiovascular and cerebrovascular events

KW - Myocardial infarction

KW - Percutaneous intervention

KW - Re-intervention

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