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Review
. 2021 Jul;44(7):899-906.
doi: 10.1002/clc.23613. Epub 2021 Jun 5.

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta-analysis

Qiuping Xie  1 , Jianguo Huang  2 , Ke Zhu  1 , Qing Chen  1
Affiliations
Review

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta-analysis

Qiuping Xie et al. Clin Cardiol. 2021 Jul.

Abstract

Previous meta-analyses showed that coronary artery bypass grafting (CABG) has lower all-cause mortality than percutaneous coronary intervention (PCI) for the management of coronary heart disease (CHD), but the long-term outcomes were not analyzed thoroughly in patients with type 2 diabetes mellitus (T2DM). To perform a meta-analysis of randomized controlled trials (RCTs) to explore the long-term effectiveness between CABG and PCI in patients with T2DM and study the temporal trends using a cumulative meta-analysis. PubMed, Embase, Cochrane library, and Clinical Trials Registry for eligible RCTs published up to September 2020. The outcomes were all-cause death, cardiac death, myocardial infarction, repeat revascularization, and stroke. Nine RCTs and 4566 patients were included. CABG resulted in better outcomes than PCI in terms of all-cause death (RR = 1.41, 95%CI: 1.22-1.63, p < 0.001), cardiac death (RR = 1.56, 95%CI: 1.25-1.95, p < 0.001), and repeat revascularization (RR = 2.68, 95%CI: 1.86-3.85, p < 0.001), but with difference regarding the occurrence of myocardial infarction (RR = 1.20, 95%CI: 0.78-1.85, p = 0.414), while PCI was associated with better outcomes in terms of stroke occurrence (RR = 0.51, 95%CI: 0.34-0.77, p = 0.001). The cumulative meta-analysis for all-cause death showed that the differences between CABG and PCI started to be significant at 3 years of follow-up, while the difference became significant at 5 years for cardiac death. In patients with CHD and T2DM, CABG results in better outcomes than PCI in terms of all-cause death, cardiac mortality, and repeat revascularization, while PCI had better outcomes in terms of stroke. The differences are mainly observed over the long-term follow-up.

Keywords: coronary artery bypass graft; coronary heart disease; meta-analysis; mortality; percutaneous coronary intervention; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare no potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Effect of coronary artery bypass graft and percutaneous coronary intervention on all‐cause death. (A). within the longest follow‐up. (B). cumulative meta‐analysis
FIGURE 2
FIGURE 2
Effect of coronary artery bypass graft and percutaneous coronary intervention on cardiac death. (A). within the longest follow‐up. (B). cumulative meta‐analysis
FIGURE 3
FIGURE 3
Effect of coronary artery bypass graft and percutaneous coronary intervention on myocardial infarction. (A). within the longest follow‐up. (B). cumulative meta‐analysis
FIGURE 4
FIGURE 4
Effect of coronary artery bypass graft and percutaneous coronary intervention on repeat revascularization (within the longest follow‐up)
FIGURE 5
FIGURE 5
Effect of coronary artery bypass graft and percutaneous coronary intervention on stroke (within the longest follow‐up)
See this image and copyright information in PMC

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