Meta-Analysis Of Drug-Eluting Stent Implantation Versus Coronary Artery Bypass Surgery For Treatment Of Diabetic Patients With Multivessel Disease

Objectives:To comparative the safety and effectiveness between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in diabetic patients with multivessel disease(MVD).Background:Multivessel coronary artery disease often exists in diabetic patients. The prevalence of diabetes is increasing worldwide year by year. For patients with diabetes and coronary artery disease, coronary artery bypass graft has long been considered the first choice. With the advent of drug-eluting stents, the restenosis in stent has been solved, which improves the prognosis after PCI to a certain extent. With the development of coronary intervention and antiplatelet drugs, does the comparision of the safety and effectiveness of CABG vs. PCI in diabetic MVD patients will have different conclusion? A certain degree of ambiguities exist among previous small sample-size studies. Their conclusions are lack of reliability and accuracy.Methods:Trials about the reascularization of the diabetic patients with multivessel coronary artery disease were retrieved through Pubmed from 2000 to 2010. Evaluate trials quality and put eligble trials into the present research according to prescribed inclusion criteria. Extract the information of the mortality, myocardial infarction (MI) incidence, cerebrovascular event (CVA) incidence, repeat reascularization rate, major adverse cardiac cerebrovascular events(MACCE) frequency. RevMan5.0.21 software was used to evaluate the safety and effectiveness of CABG vs. PCI.Results:This meta-analysis included 10 clinical trials, which account for 4262 diabetic patients with multivessels disease. The result showed CABG significantly reduced Death rate, combined Death/MI/CVA incidence, repeat reascularization rate and MACCE incidence. The mortality in CABG group is significantly lower than that in PCI group (4.26% vs 7.75%; OR 0.53; 95%CI 0.4-0.7; P<0.00001). CABG slightly reduced MI incidence, but there is no statistically significant difference (3.62% vs 4.28%; OR 0.67; 95%CI 0.45-1.00; P=0.05). The incidence of CVA was significantly higher in CABG group than PCI group (2.7% vs 0.91%; OR 2.9%; 95%CI 1.55-5.44; P=0.0009). There were statistically significant differences between the two groups. There was no statistically significant difference between the two groups in combined Death/MI/CVA incidence(10.5% vs 11.7%; OR 0.89%; 95%CI 0.65-1.23; P=0.49). MACCE incidence in PCI group was significantly higher (11.6% vs 22.7%; OR 0.44%; 95%CI 0.36-0.53; P<0.00001). And repeat reascularization rate was higher in CABG group than PCI group (4.40% vs 15.6%; OR 0.24%; 95%CI 0.13-0.43; P<0.00001)Conclusion:Through the meta-analysis of 10 clinical trials, we can find CABG is associated with lower mortality, reduced incidence of MACCE and repeat reascularization, but higher incidence of cerebrovascular events. In view of study limitations, we look forward to more and more clinical randomized trial results published, such as FREEDOM research, guiding clinical reascularization of diabetic patients with multivessel disease.