Meta-Analysis of Studies Comparing Coronary Artery Bypass Grafting With Drug-Eluting Stenting in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease

被引:47
|
作者
Lee, Michael S. [1 ]
Yang, Tae [1 ]
Dhoot, Jashdeep [1 ]
Iqbal, Zahid [1 ]
Liao, Hsini [2 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Div Cardiol, Los Angeles, CA 90095 USA
[2] Boston Sci Corp, Maple Grove, MN USA
来源
AMERICAN JOURNAL OF CARDIOLOGY | 2010年 / 105卷 / 11期
关键词
FOLLOW-UP; TRIAL; INTERVENTION; REVASCULARIZATION; OUTCOMES; SURGERY; IMPLANTATION; ANGIOPLASTY;
D O I
10.1016/j.amjcard.2010.01.009
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
This meta-analysis was undertaken to assess the efficacy and safety of coronary artery bypass grafting (CABG) compared to drug-eluting stenting (DES) in patients with diabetes mellitus and multivessel coronary artery disease (CAD). CABG has been the preferred revascularization strategy in patients with diabetes compared to DES. Drug-eluting stents reduce the rate of target vessel revascularization compared to bare-metal stents. The ideal revascularization strategy for patients with diabetes with multivessel CAD in the DES era is unknown. A search of published reports was performed to identify clinical studies comparing CABG with DES in patients with diabetes with multivessel CAD with a minimum follow-up of 1 year. Five studies including 1,543 patients with diabetes (757 who underwent CABG and 786 who underwent DES) met the selection criteria. The mean follow-up period was 18 months (range 12 to 36). Compared to DES, CABG was associated with a lower risk for major adverse cardiac events (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.36 to 0.65), driven mainly by a lower risk for repeat revascularization (OR 0.18, 95% CI 0.11 to 0.30), despite having a higher percentage of triple-vessel disease. There was no significant difference in death (OR 0.85, 95% CI 0.52 to 1.39) or myocardial infarction (OR 0.82, 95% CI 0.41 to 1.61). Patients in the CABG group had a higher risk for cerebrovascular events (OR 2.15, 95% CI 0.99 to 4.68). In conclusion, PCI with DES is safe and may represent a viable alternative to CABG for selected patients with diabetes with multivessel CAD. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:1540-1544)
引用
收藏
页码:1540 / 1544
页数:5
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