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Meta-Analysis
. 2024 Dec 20;19(1):672.
doi: 10.1186/s13019-024-03157-0.

Comparison of adverse cardiovascular event endpoints between patients with diabetes and patients without diabetes based on coronary artery plaques: a systematic review and meta-analysis

Yuchen Ma  1 , Huiying Gao  1 , Huiqun Wu  2
Affiliations
Meta-Analysis

Comparison of adverse cardiovascular event endpoints between patients with diabetes and patients without diabetes based on coronary artery plaques: a systematic review and meta-analysis

Yuchen Ma et al. J Cardiothorac Surg. .

Abstract

Background: The classification of major adverse cardiovascular event (MACE) endpoints in patients with type 2 diabetes mellitus (T2DM) and either confirmed coronary artery disease (CAD) or high CAD risk, as well as the extent of the association between T2DM and coronary plaque characteristics, remains uncertain.

Purpose: This meta-analysis aims to compare MACE endpoints between patients with diabetes and patients without diabetes based on coronary artery plaques.

Methods: We searched studies from Web of Science, PubMed, Embase, and the Cochrane Library up until September 1, 2023. Two independent researchers evaluated the quality and bias of the included studies. We used odds ratio (OR) and standardized mean difference (SMD) with 95% confidence interval (CI) to assess the effect of individual lesion parameters and coronary artery plaque characteristics on MACE endpoints.

Results: Seven studies covered 1218 patients with diabetes and 3038 patients without diabetes. The follow-up time ranged from 2 to 5.4 years. The pooled results indicated that in all CAD lesions, DM was more strongly associated with MACE, myocardial infarction (MI), revascularization, and rehospitalization for unstable or progressive angina. The pooled OR was 1.82 (95% CI: 1.42 to 2.33, I2 = 0%, P < 0.00001) for MACE, 2.36 (95% CI: 1.47 to 3.79, I2 = 0%, P = 0.0004) for MI, 1.83 (95% CI: 1.33 to 2.53, I2 = 0%, P = 0.0002) for revascularization, and 1.65 (95% CI: 1.20 to 2.27, I2 = 0%, P = 0.002) for rehospitalization respectively. Subgroup analysis of culprit lesions (CLs) revealed significant differences between DM and non-DM for MACE, MI, revascularization, and stent thrombosis. While non-culprit lesions (NCLs) showed differences for MACE, MI, revascularization, and rehospitalization between the two groups.

Conclusion: The rates of MACE, MI, and revascularization are greater in DM than in non-DM patients in terms of all lesions, CLs, and NCLs. Except for CLs, the readmission rate is greater for unstable or progressive angina. Plaque characteristics are similar between patients with and without diabetes. Prospero registration number CRD42023474226.

Keywords: Coronary artery disease; Coronary plaque characteristics; Diabetes; Major adverse cardiovascular events.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. This is an retrospective study. The Nantong University Research Ethics Committee has confirmed that no ethical approval is required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of literature search and selection of included studies for this Meta-analysis
Fig. 2
Fig. 2
The risk of bias summary
Fig. 3
Fig. 3
Forest plot of comparison between patients with and without diabetes regarding to MACE endpoints in all lesions
Fig. 4
Fig. 4
Forest plot of comparison between patients with and without diabetes regarding to MACE endpoints in CLs
Fig. 5
Fig. 5
Forest plot of comparison between patients with and without diabetes regarding to MACE endpoints in NCLs
Fig. 6
Fig. 6
Forest plot of comparison between patients with and without diabetes regarding to MACE endpoints in indeterminate lesions
Fig. 7
Fig. 7
Forest plot of comparison between patients with and without diabetes regarding to qualitative measures of coronary plaque compositions
Fig. 8
Fig. 8
Forest plot of comparison between patients with and without diabetes regarding to quantitative measures of coronary plaque compositions
See this image and copyright information in PMC

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