Effectiveness and Safety of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention for Coronary Heart Disease Combined with Diabetic Mellitus: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Junhong , AIKEBAER , KY Inamdar ,  MULATi

Department of Cardiac Surgery Division One, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

MULATi, Email: muratvkili@hotmail.com

Keywords：

Coronary artery bypass grafting (CABG); Percutaneous coronary intervention (PCI); Drug-eluting stent (DES); Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.20120174

Video：

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Objective 　To evaluate the effectiveness and security through meta-analysis of a comprehensive study of efficacy of coronary artery bypass grafting (CABG) versus drug-eluting stent percutaneous coronary intervention (DES-PCI), for diabetes mellitus with multi-vessel coronary disease.
Methods 　Databases including The Cochrane Library, PubMed, MEDLINE, EMbase, CBM, CNKI, WanFang Data and VIP were searched from their establishment dates to 2010. Published information and conference papers including references were handsearched. Relevant randomized controlled trials (RCTs) on diabetic patients with coronary multi-vessel disease treated with revascularization were collected and screened by two reviewers independently. After data extraction and quality assessment of the included studies, meta-analysis was performed using RevMan 5.0.
Results 　A total of eight studies involving a total of 3 689 cases (CABG group: 1 814 cases; DES-PCI group: 1 875 cases) were included. Results of meta-analyses showed that: compared with the DES-PCI group, the CABG group could significantly reduce postoperative repeat revascularization rate (OR=0.27, 95% CI 0.10 to 0.69, P=0.006) and major cardio-cerebral vascular events (OR=0.49, 95% CI 0.38 to 0.62, P lt;0.000 01). But in reducing mortality rate (OR=0.84, 95%CI 0.64 to 1.10, P=0.21), cerebrovascular events (OR=2.00, 95%CI 0.97 to 4.14, P=0.06) and myocardial infarction incidence rate (OR=0.92, 95%CI 0.53 to 1.59, P=0.75), there were no significant differences between the two groups.
Conclusion 　CABG is superior to DES-PCI in the treatment of diabetic patients with multi-vessel disease. However, due to the limitation of the quality and quantity of the included studies, the above conclusion should be tested by conducting more large-scale, multi-center and prospective RCTs in future.

Citation： LI Junhong,AIKEBAER,KY Inamdar,MULATi. Effectiveness and Safety of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention for Coronary Heart Disease Combined with Diabetic Mellitus: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(9): 1116-1121. doi: 10.7507/1672-2531.20120174 Copy

1.	Daemen J, Kuek KH, Maeaya C, et al. Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial. J Am Coll Cardiol, 2008, 52(24): 1957-1967.
2.	Yang JH, Gwon HC, Cho SJ, et al. Comparison of coronary artery bypass grafting with drug-eluting stent implantation for the treatment of multivessel coronary artery disease. Ann Thorac Surg, 2008, 85(1): 65-70.
3.	Tarantini G, Ramondo A, Napodano M. PCI versus CABG for multivessel coronary disease indiabetics. Catheter Cardiovasc Intery, 2009, 73(1): 50-58.
4.	Qiao Y, Ma C, Nie S, et al. Twelve months clinical outcome of drug-eluting stents implantation or coronary artery bypass surgery for the treatment of diabetic patients with multivessel disease. Clin Cardiol, 2009, 32(8): E24-30.
5.	Li Y, Zheng Z, Xu B, et al. Comparison of drug-eluting stents and coronary artery bypass surgery for the treatment of multivessel coronary disease: three-year follow-up results from a single institution. Circulation, 2009, 119(15): 2040-2050.
6.	Kapur A, Bartolini D, Finlay MC, et al. The bypass angioplasty revascularization in type 1 and 2 diabetes study: 5-year follow-up of revascularization with percutaneous coronary intervention versus coronary artery bypass grafting in diabetic patients with multivessel disease. J Cardiovasc Med, 2010, 11(1): 26-33.
7.	Banning AP, Westabys, Morice MC, et al. Diabetic and nondiabetic Patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol, 2010, 55(11): 1067-1075.
8.	Kapur A, Hall RJ, Malik IS, et al. Randomized comparison of percutaneous coronary Intervention with coronary artery bypass grafting in diabetic Patients: 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. J Am Coll Cardiol, 2010, 55(5): 432-440.
9.	Uddin SN, Malik F, Bari MA, et al. Angiographic severity and extent of coronary artery disease in patients with type 2 diabetes mellitus. Mymensingh Med J, 2005, 14(1): 32-37.
10.	Seheen AJ, warze’e F, Legrand VM. Drug-eluting stents: Meta-analysis in diabetic patients. Eur Heart J, 2004, 25: 2167-2168.
11.	Banmgart D, Klauss V, Baer F, et al. One-year results of the SCORPIUS study: a German Multicenter investigation on the effectiveness of sirolimus-eluting stents in diabetic patients. Joumal of the Ameriean College of Cardiology, 2007, 50: 1627-1634.
12.	Tu JV, Bowen J, Chiu M, et al. Effectiveness and safety of drug-eluting stents in Ontario. The New England Journal of Medicine, 2007, 357: 1393-1402.
13.	Stettler C, Allemann S, wandel S, et al. Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis. British Medical Journal, 2008, 337: al331.
14.	Serruys PW, Ong ATL, van Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. Joumal of the Ameriean College of Cardiology, 2005, 46: 575-581.
15.	Rodriguez AE，Baldi J, Pereira CF, et al. Five year follow-up of the argentine randomized trial Of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). Journal of the American College of Cardiology, 2005, 46: 582-588.
16.	Hueb W, Lopes NH, Gersh BJ, et al. Five-year follow-up of the Medieine, Angioplasty, or Surgery Study (MASSII): a randomized controlled clinieal trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation, 2007, 115: 1082-1089.
17.	Sabate M, Jimenez-Quevedo P, Angiolillo DJ, et al. Randomized comparison of sirolimus-eluting stent versus standard stent for percutaneous coronary revascularization in diabetic patients: the diabetes and sirolimus-eluting stent (DIBETES) trial. Circulation, 2005, 112: 2175-2183.
18.	Holmes DR, Leon MB, Moses JW, et al. Analysis of l-year clinical outcomes in the SIRIUS trial: a randomized trial of sirolimuseluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation, 2004, 109: 634-640.
19.	Hermiller JB, Raizner A, Cannon L, et al. Outeomes with the Polymer-based paclitaxel-eluting TAXUS stent in patients with diabetes mellitus: The TAXUS-IV trial. J Am Coll Cardiol, 2005, 45: 1172-1179.
20.	Mclellan CS, Ghali WA, Labinaz M, et al. Association between completeness of percutaneous coronary revascularization and postprocedure outcomes. Am Heart J, 2005, 150: 800-806.

1. Daemen J, Kuek KH, Maeaya C, et al. Multivessel coronary revascularization in patients with and without diabetes mellitus: 3-year follow-up of the ARTS-II (Arterial Revascularization Therapies Study-Part II) trial. J Am Coll Cardiol, 2008, 52(24): 1957-1967.
2. Yang JH, Gwon HC, Cho SJ, et al. Comparison of coronary artery bypass grafting with drug-eluting stent implantation for the treatment of multivessel coronary artery disease. Ann Thorac Surg, 2008, 85(1): 65-70.
3. Tarantini G, Ramondo A, Napodano M. PCI versus CABG for multivessel coronary disease indiabetics. Catheter Cardiovasc Intery, 2009, 73(1): 50-58.
4. Qiao Y, Ma C, Nie S, et al. Twelve months clinical outcome of drug-eluting stents implantation or coronary artery bypass surgery for the treatment of diabetic patients with multivessel disease. Clin Cardiol, 2009, 32(8): E24-30.
5. Li Y, Zheng Z, Xu B, et al. Comparison of drug-eluting stents and coronary artery bypass surgery for the treatment of multivessel coronary disease: three-year follow-up results from a single institution. Circulation, 2009, 119(15): 2040-2050.
6. Kapur A, Bartolini D, Finlay MC, et al. The bypass angioplasty revascularization in type 1 and 2 diabetes study: 5-year follow-up of revascularization with percutaneous coronary intervention versus coronary artery bypass grafting in diabetic patients with multivessel disease. J Cardiovasc Med, 2010, 11(1): 26-33.
7. Banning AP, Westabys, Morice MC, et al. Diabetic and nondiabetic Patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am Coll Cardiol, 2010, 55(11): 1067-1075.
8. Kapur A, Hall RJ, Malik IS, et al. Randomized comparison of percutaneous coronary Intervention with coronary artery bypass grafting in diabetic Patients: 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial. J Am Coll Cardiol, 2010, 55(5): 432-440.
9. Uddin SN, Malik F, Bari MA, et al. Angiographic severity and extent of coronary artery disease in patients with type 2 diabetes mellitus. Mymensingh Med J, 2005, 14(1): 32-37.
10. Seheen AJ, warze’e F, Legrand VM. Drug-eluting stents: Meta-analysis in diabetic patients. Eur Heart J, 2004, 25: 2167-2168.
11. Banmgart D, Klauss V, Baer F, et al. One-year results of the SCORPIUS study: a German Multicenter investigation on the effectiveness of sirolimus-eluting stents in diabetic patients. Joumal of the Ameriean College of Cardiology, 2007, 50: 1627-1634.
12. Tu JV, Bowen J, Chiu M, et al. Effectiveness and safety of drug-eluting stents in Ontario. The New England Journal of Medicine, 2007, 357: 1393-1402.
13. Stettler C, Allemann S, wandel S, et al. Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis. British Medical Journal, 2008, 337: al331.
14. Serruys PW, Ong ATL, van Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. Joumal of the Ameriean College of Cardiology, 2005, 46: 575-581.
15. Rodriguez AE，Baldi J, Pereira CF, et al. Five year follow-up of the argentine randomized trial Of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). Journal of the American College of Cardiology, 2005, 46: 582-588.
16. Hueb W, Lopes NH, Gersh BJ, et al. Five-year follow-up of the Medieine, Angioplasty, or Surgery Study (MASSII): a randomized controlled clinieal trial of 3 therapeutic strategies for multivessel coronary artery disease. Circulation, 2007, 115: 1082-1089.
17. Sabate M, Jimenez-Quevedo P, Angiolillo DJ, et al. Randomized comparison of sirolimus-eluting stent versus standard stent for percutaneous coronary revascularization in diabetic patients: the diabetes and sirolimus-eluting stent (DIBETES) trial. Circulation, 2005, 112: 2175-2183.
18. Holmes DR, Leon MB, Moses JW, et al. Analysis of l-year clinical outcomes in the SIRIUS trial: a randomized trial of sirolimuseluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation, 2004, 109: 634-640.
19. Hermiller JB, Raizner A, Cannon L, et al. Outeomes with the Polymer-based paclitaxel-eluting TAXUS stent in patients with diabetes mellitus: The TAXUS-IV trial. J Am Coll Cardiol, 2005, 45: 1172-1179.
20. Mclellan CS, Ghali WA, Labinaz M, et al. Association between completeness of percutaneous coronary revascularization and postprocedure outcomes. Am Heart J, 2005, 150: 800-806.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention for Coronary Heart Disease Combined with Diabetic Mellitus: A Meta-Analysis

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