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Meta-Analysis
. 2016 Jan 6:15:2.
doi: 10.1186/s12933-015-0323-z.

Coronary artery bypass surgery compared with percutaneous coronary interventions in patients with insulin-treated type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials

Pravesh Kumar Bundhun  1 , Zi Jia Wu  2 , Meng-Hua Chen  3
Affiliations
Meta-Analysis

Coronary artery bypass surgery compared with percutaneous coronary interventions in patients with insulin-treated type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials

Pravesh Kumar Bundhun et al. Cardiovasc Diabetol. .

Abstract

Background: Data regarding the long-term clinical outcomes in patients with insulin-treated type 2 diabetes mellitus (ITDM) revascularized by either coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) are still controversial. We sought to compare the long-term (≥1 year) adverse clinical outcomes in patients with ITDM who underwent revascularization by either CABG or PCI.

Methods: Randomized Controlled Trials (RCTs) comparing the long-term clinical outcomes in patients with ITDM and non-ITDM revascularized by either CABG or PCI were searched from electronic databases. Data for patients with ITDM were carefully retrieved. Odd Ratio (OR) with 95 % confidence interval (CI) was used to express the pooled effect on discontinuous variables and the pooled analyses were performed with RevMan 5.3.

Results: Six RCTs involving 10 studies, with a total of 1297 patients with ITDM were analyzed (639 patients from the CABG group and 658 patients from the PCI group). CABG was associated with a significantly lower mortality rate compared to PCI with OR: 0.59, 95 % CI 0.42-0.85; P = 0.004. Major adverse cardiovascular and cerebrovascular events as well as repeated revascularization were also significantly lower in the CABG group with OR: 0.51, 95 % CI 0.27-0.99; P = 0.03 and OR 0.34, 95 % CI 0.24-0.49; P < 0.00001 respectively. However, compared to PCI, the rate of stroke was higher in the CABG group with OR: 1.41, 95 % CI 0.64-3.09; P = 0.40, but this result was not statistically significant.

Conclusion: CABG was associated with significantly lower long-term adverse clinical outcomes compared to PCI in patients with ITDM. However, due to an insignificantly higher rate of stroke in the CABG group, further researches with a larger number of randomized patients are required to completely solve this issue.

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Figures

Fig. 1
Fig. 1
Flow diagram of the study selection. 456 articles were identified from Medline and EMBASE and further 11 relevant articles were identified through reference lists of highly selective studies. After filtering the duplicates, 360 articles were excluded since they were not related to our topic. 46 full-text articles were assessed for eligibility. Meta-analyses, observational studies, and letters to editor were further eliminated (n = 26). Studies including data for patients with ITDM which were unable to be retrieved were also eliminated (n = 10). Finally 6 RCTs involving 10 studies were selected for this systematic review and meta-analysis
Fig. 2
Fig. 2
Forest plot comparing the adverse clinical outcomes between the CABG and PCI groups
Fig. 3
Fig. 3
Forest plot comparing major adverse cardiovascular and cerebrovascular events between the CABG and PCI groups
Fig. 4
Fig. 4
Forest plot comparing mortality at 1 and 5 years between the CABG and PCI groups
Fig. 5
Fig. 5
Funnel plot assessing publication bias
See this image and copyright information in PMC

References

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