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CABG, newer-generation DES yielded similar mortality rates in patients with diabetes
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Comparable mortality rates were reported for patients with diabetes treated with CABG or PCI using a cobalt-chromium everolimus-eluting stent.
Sripal Bangalore, MD, with the New York University School of Medicine, and fellow researchers suggested that previous studies comparing CABG with PCI demonstrated reduced mortality among patients with diabetes, but that those studies were conducted with older-generation stents. They undertook the current review of randomized trials from Pubmed, EMBASE and CENTRAL databases to determine whether similar outcomes occur with newer-generation drug-eluting stents.
The analysis included 24,015 patients with diabetes from 68 randomized trials. More than 71,500 patient-years of follow-up underwent analysis.
All-cause mortality served as the primary outcome measure, with MI, repeat revascularization and stroke serving as secondary endpoints.
Sripal Bangalore
The researchers also performed mixed treatment comparison analyses.
Compared with CABG, PCI with a paclitaxel-eluting stent yielded an RR of 1.57 (95% CI, 1.15-2.19) for mortality. A sirolimus-eluting stent also was associated with an increase in mortality (RR=1.43; 95% CI, 1.06-1.97).
However, there was no association with mortality with the cobalt-chromium everolimus-eluting stent (RR=1.11; 95% CI, 0.67-1.84).
Excess repeat revascularization occurred with PCI compared with CABG, whereas a progressive decrease in repeat revascularization occurred compared with CABG for several iterations of stents, from plain old balloon angioplasty (341% increase) and bare-metal stents (218% increase) to paclitaxel- (81% increase) and sirolimus-eluting (47% increase) stents.
For the cobalt-chromium everolimus-eluting stent, no statistically significant increase in repeat revascularization was reported (RR=1.31; 0.74-2.29). The researchers noted, however, that the point estimate favored CABG.
A numerical increase in stroke occurred in the CABG group.
“In patients with diabetes mellitus, evidence from indirect comparison shows similar mortality between CABG and PCI using cobalt-chromium everolimus-eluting stent,” Bangalore and colleagues concluded. They added that the conclusions regarding excess stroke with CABG and increased repeat revascularization with PCI with the cobalt-chromium everolimus-eluting stent should be tested in future trials.
Disclosure: The researchers report financial disclosures with Abbott/Abbott Vascular, Boehringer Ingelheim, Boston Scientific, Daiichi Sankyo, Gilead, Johnson & Johnson, Medtronic and Pfizer.
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