Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis
© 2014 Elsevier Ireland Ltd. All rights reserved. Background: Currently, the appropriateness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for patients with diabetes (DM) and multi-vessel disease (MVD) is uncertain due to li...
| Main Authors: | , , , , , , |
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| Format: | Journal Article |
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Elsevier Ireland Ltd
2014
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| Online Access: | http://hdl.handle.net/20.500.11937/8463 |
| _version_ | 1848745666013036544 |
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| author | Ariyaratne, T. Ademi, Z. Yap, C. Billah, B. Rosenfeldt, F. Yan, B. Reid, Christopher |
| author_facet | Ariyaratne, T. Ademi, Z. Yap, C. Billah, B. Rosenfeldt, F. Yan, B. Reid, Christopher |
| author_sort | Ariyaratne, T. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 2014 Elsevier Ireland Ltd. All rights reserved. Background: Currently, the appropriateness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for patients with diabetes (DM) and multi-vessel disease (MVD) is uncertain due to limited evidence from few randomised controlled trials (RCTs). We aimed to compare the clinical effectiveness of CABG versus PCI-DES in DM-MVD patients using an evidence-based approach. Methods: A systematic review and meta-analyses were conducted to compare the risk of all-cause mortality, myocardial infarction (MI), repeat revascularisation, cerebrovascular events (CVE), and major adverse cardiac or cerebrovascular events (MACCE). Results: A total of 1,837 and 3,052DM-MVD patientswere pooled fromfour RCTs (FREEDOM, SYNTAX,VA CARDS, and CARDia) and five non-randomised studies. At mean follow-up of 3 years, CABG comparedwith PCI-DES was associated with a lower risk of all-cause mortality and MI in RCTs. By contrast, no significant differences were observed in the mean 3.5-year risk of all-cause mortality and MI in non-randomised trials. However, the risk of repeat revascularisations following PCI-DES compared with CABG was 2.3 (95% CI = 1.8-2.8) and 3.0 (2.3- 4.2)-folds higher in RCTs and non-randomised trials, respectively. Accordingly, the risk of MACCE at 3 years following CABG compared with PCI-DES was lower in both RCTs and non-randomised trials [0.65 (: 0.55-0.77); and 0.77 (0.60-0.98), respectively]. Conclusions: Based on our pooled results, we recommend CABG compared with PCI-DES for patients with DM-MVD. Although non-randomised trials suggest no additional survival-, MI-, and CVE- benefit from CABG over PCI-DES, these results should be interpreted with care. |
| first_indexed | 2025-11-14T06:20:59Z |
| format | Journal Article |
| id | curtin-20.500.11937-8463 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T06:20:59Z |
| publishDate | 2014 |
| publisher | Elsevier Ireland Ltd |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-84632017-09-13T14:35:42Z Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis Ariyaratne, T. Ademi, Z. Yap, C. Billah, B. Rosenfeldt, F. Yan, B. Reid, Christopher © 2014 Elsevier Ireland Ltd. All rights reserved. Background: Currently, the appropriateness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for patients with diabetes (DM) and multi-vessel disease (MVD) is uncertain due to limited evidence from few randomised controlled trials (RCTs). We aimed to compare the clinical effectiveness of CABG versus PCI-DES in DM-MVD patients using an evidence-based approach. Methods: A systematic review and meta-analyses were conducted to compare the risk of all-cause mortality, myocardial infarction (MI), repeat revascularisation, cerebrovascular events (CVE), and major adverse cardiac or cerebrovascular events (MACCE). Results: A total of 1,837 and 3,052DM-MVD patientswere pooled fromfour RCTs (FREEDOM, SYNTAX,VA CARDS, and CARDia) and five non-randomised studies. At mean follow-up of 3 years, CABG comparedwith PCI-DES was associated with a lower risk of all-cause mortality and MI in RCTs. By contrast, no significant differences were observed in the mean 3.5-year risk of all-cause mortality and MI in non-randomised trials. However, the risk of repeat revascularisations following PCI-DES compared with CABG was 2.3 (95% CI = 1.8-2.8) and 3.0 (2.3- 4.2)-folds higher in RCTs and non-randomised trials, respectively. Accordingly, the risk of MACCE at 3 years following CABG compared with PCI-DES was lower in both RCTs and non-randomised trials [0.65 (: 0.55-0.77); and 0.77 (0.60-0.98), respectively]. Conclusions: Based on our pooled results, we recommend CABG compared with PCI-DES for patients with DM-MVD. Although non-randomised trials suggest no additional survival-, MI-, and CVE- benefit from CABG over PCI-DES, these results should be interpreted with care. 2014 Journal Article http://hdl.handle.net/20.500.11937/8463 10.1016/j.ijcard.2014.06.072 Elsevier Ireland Ltd restricted |
| spellingShingle | Ariyaratne, T. Ademi, Z. Yap, C. Billah, B. Rosenfeldt, F. Yan, B. Reid, Christopher Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis |
| title | Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis |
| title_full | Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis |
| title_fullStr | Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis |
| title_full_unstemmed | Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis |
| title_short | Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis |
| title_sort | prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: an updated systematic review and meta-analysis |
| url | http://hdl.handle.net/20.500.11937/8463 |