Document Detail

Comparison of bypass surgery and drug-eluting stenting in diabetic patients with left main and/or multivessel disease: A systematic review and meta-analysis of randomized and nonrandomized studies.
MedLine Citation:
PMID:  24846507     Owner:  NLM     Status:  Publisher    
BACKGROUND: With the advances in the interventional field, the choice between coronary artery bypass grafting (CABG) and percutaneous coronary intervention with drug-eluting stents (PCI-DES) for the diabetic subset with left main (LM) and/or multivessel disease (MVD) remain consistently controversial.
METHODS AND RESULTS: We conducted a systematical review of randomized controlled trials (RCTs) and observational controlled trial (OCTs) comparing the two strategies for the diabetic subset with LM and/or MVD. PubMed, EMBASE, CENTRAL databases, Google Scholar and SINOMED: were systematically searched for eligible studies without language and publication restriction. We identified 19 trials (4 randomized and 15 nonrandomized), enrolling 5805 patients in OCTs and 3060 patients in RCTs respectively. PCI-DES was associated with higher mortality compared with CABG (11.7%DES vs. 9.1%CABG, RR 1.23, 95%CI [1.00, 1.53], P=0.06). Patients after PCI-DES had the higher prevalence of myocardial infarction (MI) when compared with CABG (8.5%DES vs. 4.6%CABG, RR 1.68, 95%CI [1.20, 2.37], P=0.003). PCI-DES patients were at substantially lower risk of stroke (2.0%DES vs. 3.9%CABG, RR 0.51, 95%CI [0.39, 0.67], P<0.00001), but at several-folder higher risk of repeat revascularization (19.0%DES vs. 6.3%CABG, RR 2.95, 95%CI [2.46, 3.55] P<0.00001). The OCT patients risked a lower mortality as compared with RCT patients (9.6%OCTs vs. 11.9% RCTs, RR0.81, 95%CI [0.71, 0.92], P=0.001).
CONCLUSIONS: CABG for patients with diabetes mellitus and LM and/or MVD had advantages over PCI-DES in all-cause death, nonfatal MI, and repeat revascularization, but the substantial disadvantage in nonfatal stroke. The high-selected patients (RCTs) risked a higher mortality than the real-world patients (OCTs).
Fumei Huang; Wenyuan Lai; Choileng Chan; Hui Peng; Feifei Zhang; Yi Zhou; Shuen Teng; Zheng Huang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-20
Journal Detail:
Title:  Cardiology journal     Volume:  -     ISSN:  1897-5593     ISO Abbreviation:  Cardiol J     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-5-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101392712     Medline TA:  Cardiol J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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