Long-term outcomes of percutaneous versus surgical revascularization in patients with diabetes and left main coronary artery disease: A meta-analysis of randomized controlled trials

Pedro E P Carvalho; Thiago M A Veiga; Felipe S L Machado; Gabriel V Porto; Jacqueline Pirez; Manuel Rivera; Pedro C Melo; Joao Braghiroli; Rhanderson Cardoso

doi:10.1111/jocs.17046

Long-term outcomes of percutaneous versus surgical revascularization in patients with diabetes and left main coronary artery disease: A meta-analysis of randomized controlled trials

J Card Surg. 2022 Dec;37(12):4646-4653. doi: 10.1111/jocs.17046. Epub 2022 Oct 19.

Authors

Pedro E P Carvalho¹, Thiago M A Veiga¹, Felipe S L Machado¹, Gabriel V Porto¹, Jacqueline Pirez², Manuel Rivera³, Pedro C Melo⁴, Joao Braghiroli⁵, Rhanderson Cardoso⁶

Affiliations

¹ Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
² Department of Medicine, Cesumar University, Maringa, Brazil.
³ Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA.
⁴ Cardiovascular Research Foundation, New York, New York, USA.
⁵ Jackson Memorial Hospital, Miami, Florida, USA.
⁶ Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 36259716
DOI: 10.1111/jocs.17046

Abstract

Background: The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established.

Objectives: To perform a meta-analysis evaluating the long-term outcomes after PCI with drug-eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD.

Methods: MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long-term effects of these interventions, we restricted this analysis to studies with a minimum follow-up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations.

Results: Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all-cause mortality (RR: 1.21; 95% CI: 0.86-1.71; p = .27; I² = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76-2.18; p = .34; I² = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61-1.45; p = .79; I² = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18-0.94; p = .04; I² = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44-2.75; p < .001; I² = 0%). The risk of the composite outcome of all-cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09-1.56; p = .004; I² = 0%).

Conclusion: In this meta-analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG.

Keywords: coronary artery bypass graft surgery; diabetes mellitus; left main coronary artery disease; percutaneous coronary interventions.

Publication types

Meta-Analysis

MeSH terms

Coronary Artery Disease* / complications
Coronary Artery Disease* / surgery
Diabetes Mellitus* / epidemiology
Drug-Eluting Stents* / adverse effects
Humans
Myocardial Infarction* / complications
Myocardial Infarction* / etiology
Percutaneous Coronary Intervention* / adverse effects
Randomized Controlled Trials as Topic
Stroke* / epidemiology
Stroke* / etiology
Treatment Outcome