Coronary artery bypass grafting is associated with a one-third reduction in all-cause mortality among patients with diabetes compared with percutaneous coronary intervention with either bare-metal stents or drug-eluting stents, according to a meta-analysis published in The Lancet Diabetes and Endocrinology.
“The robust reductions in all-cause mortality argue strongly in favor of CABG over PCI in patients with diabetes and multi-vessel disease, and represent an important call to action for physicians and patients at-large,” Subodh Verma, MD, of the division of cardiac surgery at St. Michael’s Hospital in Toronto, and colleagues wrote.
The researchers identified four randomized control trials using bare-metal stents and four studies using drug-eluting stents. In eight studies (n=3,131) with assignment to CABG vs. PCI, patients with diabetes displayed reduced all-cause mortality (RR=0.67; 95% CI, 0.52-0.86), according to 5-year follow-up data. Additionally, six studies that looked at 3,258 patients showed a need for repeat revascularization (RR=0.41; 95% CI, 0.29-0.59), but the need was significantly lower in patients with diabetes who were treated with CABG vs. PCI.
CABG was also linked to an increased risk for nonfatal stroke among 2,844 patients from five trials compared with PCI (RR=1.72; 95% CI, 1.18-2.53), according to data.
Other results showed no significant differences in nonfatal myocardial infarction rates between CABG and PCI at 1 year or 5 years in six trials looking at 2,970 patients. Moreover, no differences were reported in treatment effects among patients with or without diabetes for any of the other outcomes (mortality at 1-year, MI, stroke, or need for revascularization at 1 or 5 years), the researchers wrote.
Disclosure: This study was funded by the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, and Canada Research Chairs program. The researchers report no relevant financial disclosures.