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CABG outperformed PCI in patients with diabetes
PCI was associated with increases in mortality and a composite of adverse events compared with CABG in patients with diabetes, leading researchers to conclude that CABG may be the preferred revascularization technique in this patient population.
Researchers of the retrospective analysis, which was published in the Annals of Internal Medicine, reviewed several databases for randomized controlled trials comparing PCI with drug-eluting or bare-metal stents and CABG in patients with diabetes and multivessel or left main CAD. Forty studies conducted between Jan. 1, 1990 and June 1, 2014 underwent analysis for study design, quality, patient characteristics, follow-up duration and patient outcomes. According to the researchers, the studies were combined using a Bayesian network meta-analysis, which accounted for the variation in stent choice.
A composite of all-cause death, non-fatal MI and stroke served as the primary outcome measure.
PCI was associated with an increase in this composite outcome (OR=1.33; 95% credible interval [CrI], 1.01-1.65). Mortality also increased with PCI (OR=1.44; 95% CrI, 1.05-1.91), but there was no significant difference in the frequency of MI (OR=1.33; 95% CrI, 0.86-1.95). In addition, there were fewer strokes in the PCI group (OR=0.56; 95% CrI, 0.36-0.88).
The researchers noted heterogeneity in study design as a limitation, along with the fact that the mortality findings were largely driven by a single study (FREEDOM), and that cost and nonvascular complications did not undergo analysis.
“[CABG] seems to be the preferred revascularization technique in diabetics, especially if long- term survival is anticipated,” the researchers concluded. “However, because of residual uncertainties and increased risk for stroke with CABG, clinical judgment is required when choosing a revascularization technique in patients with diabetes.”
Disclosure: The researchers report no relevant financial disclosures.