Skip to main content
Top
Published in: Diabetes Therapy 5/2018

Open Access 01-10-2018 | Brief Report

Reassessing Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients with Type 2 Diabetes Mellitus: A Brief Updated Analytical Report (2015–2017)

Authors: Xia Dai, Zu-chun Luo, Lu Zhai, Wen-piao Zhao, Feng Huang

Published in: Diabetes Therapy | Issue 5/2018

Login to get access

Abstract

Introduction

In this analysis, we aimed to systematically compare percutaneous coronary intervention (PCI) versus coronary artery bypass surgery (CABG) in terms of adverse outcomes utilizing data from a recent (2015–2017) population of patients with type 2 diabetes mellitus (T2DM).

Methods

An electronic search of recent studies (2015–2017) was carried out using ‘diabetes mellitus,’ ‘coronary artery bypass surgery,’ and ‘percutaneous coronary intervention’ as the main search terms. Uncomplicated T2DM patients with stable coronary artery disease (CAD), left main CAD, and multi-vessel disease were included. RevMan software (version 5.3) was used to calculate odds ratios (OR) and 95% confidence intervals (CIs).

Results

Among a total of 13,114 T2DM patients, CABG and PCI patients did not differ significantly in their rates of mortality (OR 0.90, 95% CI 0.61–1.31; P = 0.57) and cardiac death (OR 1.00, 95% CI 0.78–1.30; P = 0.98). However, rates of major adverse events, repeat revascularization, and myocardial infarction were significantly higher in the PCI group. Stroke rates did not significantly differ between the two groups.

Conclusion

Mortality (1–5 years) did not significantly differ between the CABG and PCI patients with T2DM. However, rates of other major adverse events were significantly higher in the PCI patients, suggesting that CABG is more advantageous than PCI in patients with T2DM.
Literature
1.
go back to reference Bangalore S, Toklu B, Feit F. Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap? Circ Cardiovasc Interv. 2014;7(4):518–25.CrossRef Bangalore S, Toklu B, Feit F. Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap? Circ Cardiovasc Interv. 2014;7(4):518–25.CrossRef
2.
go back to reference Toeg HD, Farkouh ME, Ruel M. Letter by Toeg et al regarding article “Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap?”. Circ Cardiovasc Interv. 2014;7(5):728.CrossRef Toeg HD, Farkouh ME, Ruel M. Letter by Toeg et al regarding article “Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap?”. Circ Cardiovasc Interv. 2014;7(5):728.CrossRef
3.
go back to reference Bangalore S, Toklu B, Feit F. Response to letter regarding article, “Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap?”. Circ Cardiovasc Interv. 2014;7(5):729.CrossRef Bangalore S, Toklu B, Feit F. Response to letter regarding article, “Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap?”. Circ Cardiovasc Interv. 2014;7(5):729.CrossRef
4.
go back to reference Lim JY, Deo SV, Kim WS, Altarabsheh SE, Erwin PJ, Park SJ. Drug-eluting stents versus coronary artery bypass grafting in diabetic patients with multi-vessel disease: a meta-analysis. Heart Lung Circ. 2014;23(8):717–25.CrossRef Lim JY, Deo SV, Kim WS, Altarabsheh SE, Erwin PJ, Park SJ. Drug-eluting stents versus coronary artery bypass grafting in diabetic patients with multi-vessel disease: a meta-analysis. Heart Lung Circ. 2014;23(8):717–25.CrossRef
5.
go back to reference Nicolini F, Agostinelli A, Vezzani A, Benassi F, Gherli T. CABG versus PCI in the treatment of diabetic patients affected by coronary artery disease. Int Heart J. 2014;55(6):469–73.CrossRef Nicolini F, Agostinelli A, Vezzani A, Benassi F, Gherli T. CABG versus PCI in the treatment of diabetic patients affected by coronary artery disease. Int Heart J. 2014;55(6):469–73.CrossRef
6.
go back to reference Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRef Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRef
7.
go back to reference Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRef Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRef
8.
go back to reference Baber U, Farkouh ME, Arbel Y, Muntner P, Dangas G, Mack MJ, Hamza TH, Mehran R, Fuster V. Comparative efficacy of coronary artery bypass surgery vs. percutaneous coronary intervention in patients with diabetes and multivessel coronary artery disease with or without chronic kidney disease. Eur Heart J. 2016;37(46):3440–7.CrossRef Baber U, Farkouh ME, Arbel Y, Muntner P, Dangas G, Mack MJ, Hamza TH, Mehran R, Fuster V. Comparative efficacy of coronary artery bypass surgery vs. percutaneous coronary intervention in patients with diabetes and multivessel coronary artery disease with or without chronic kidney disease. Eur Heart J. 2016;37(46):3440–7.CrossRef
9.
go back to reference Bangalore S, Guo Y, Samadashvili Z, Blecker S, Xu J, Hannan EL. Everolimus eluting stents versus coronary artery bypass graft surgery for patients with diabetes mellitus and multivessel disease. Circ Cardiovasc Interv. 2015;8(7):e002626.CrossRef Bangalore S, Guo Y, Samadashvili Z, Blecker S, Xu J, Hannan EL. Everolimus eluting stents versus coronary artery bypass graft surgery for patients with diabetes mellitus and multivessel disease. Circ Cardiovasc Interv. 2015;8(7):e002626.CrossRef
10.
go back to reference Ben-Gal Y, Mohr R, Feit F, Ohman EM, Kirtane A, Xu K, Mehran R, Stone GW. Surgical versus percutaneous coronary revascularization for multivessel disease in diabetic patients with non-ST-segment-elevation acute coronary syndrome: analysis from the Acute Catheterization and Early Intervention Triage Strategy trial. Circ Cardiovasc Interv. 2015;8(6):e002032. Ben-Gal Y, Mohr R, Feit F, Ohman EM, Kirtane A, Xu K, Mehran R, Stone GW. Surgical versus percutaneous coronary revascularization for multivessel disease in diabetic patients with non-ST-segment-elevation acute coronary syndrome: analysis from the Acute Catheterization and Early Intervention Triage Strategy trial. Circ Cardiovasc Interv. 2015;8(6):e002032.
11.
go back to reference Li HR, Hsu CP, Sung SH, Shih CC, Lin SJ, Chan WL, Wu CH, Lu TM. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with diabetic nephropathy and left main coronary artery disease. Acta Cardiol Sin. 2017;33(2):119–26.PubMedPubMedCentral Li HR, Hsu CP, Sung SH, Shih CC, Lin SJ, Chan WL, Wu CH, Lu TM. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with diabetic nephropathy and left main coronary artery disease. Acta Cardiol Sin. 2017;33(2):119–26.PubMedPubMedCentral
12.
go back to reference Marui A, Kimura T, Nishiwaki N, Mitsudo K, Komiya T, Hanyu M, Shiomi H, Tanaka S, Sakata R. Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol. 2015;115(8):1063–72.CrossRef Marui A, Kimura T, Nishiwaki N, Mitsudo K, Komiya T, Hanyu M, Shiomi H, Tanaka S, Sakata R. Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol. 2015;115(8):1063–72.CrossRef
13.
go back to reference Naito R, Miyauchi K, Konishi H, Tsuboi S, Ogita M, Dohi T, Kajimoto K, Kasai T, Tamura H, Okazaki S, Isoda K, Yamamoto T, Amano A, Daida H. Comparing mortality between coronary artery bypass grafting and percutaneous coronary intervention with drug-eluting stents in elderly with diabetes and multivessel coronary disease. Heart Vessels. 2016;31(9):1424–9.CrossRef Naito R, Miyauchi K, Konishi H, Tsuboi S, Ogita M, Dohi T, Kajimoto K, Kasai T, Tamura H, Okazaki S, Isoda K, Yamamoto T, Amano A, Daida H. Comparing mortality between coronary artery bypass grafting and percutaneous coronary intervention with drug-eluting stents in elderly with diabetes and multivessel coronary disease. Heart Vessels. 2016;31(9):1424–9.CrossRef
14.
go back to reference Li Y, Dong R, Hua K, Liu TS, Zhou SY, Zhou N, Zhang HJ. Outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention in patients aged 18–45 years with diabetes mellitus. Chin Med J (Engl). 2017;130(24):2906–15.CrossRef Li Y, Dong R, Hua K, Liu TS, Zhou SY, Zhou N, Zhang HJ. Outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention in patients aged 18–45 years with diabetes mellitus. Chin Med J (Engl). 2017;130(24):2906–15.CrossRef
15.
go back to reference Ramanathan K, Abel JG, Park JE, Fung A, Mathew V, Taylor CM, Mancini GBJ, Gao M, Ding L, Verma S, Humphries KH, Farkouh ME. Surgical versus percutaneous coronary revascularization in patients with diabetes and acute coronary syndromes. J Am Coll Cardiol. 2017;70(24):2995–3006.CrossRef Ramanathan K, Abel JG, Park JE, Fung A, Mathew V, Taylor CM, Mancini GBJ, Gao M, Ding L, Verma S, Humphries KH, Farkouh ME. Surgical versus percutaneous coronary revascularization in patients with diabetes and acute coronary syndromes. J Am Coll Cardiol. 2017;70(24):2995–3006.CrossRef
16.
go back to reference Bundhun PK, Pursun M, Teeluck AR, Bhurtu A, Soogund MZ, Huang WQ. Adverse cardiovascular outcomes associated with coronary artery bypass surgery and percutaneous coronary intervention with everolimus eluting stents: a meta-analysis. Sci Rep. 2016;6:35869.CrossRef Bundhun PK, Pursun M, Teeluck AR, Bhurtu A, Soogund MZ, Huang WQ. Adverse cardiovascular outcomes associated with coronary artery bypass surgery and percutaneous coronary intervention with everolimus eluting stents: a meta-analysis. Sci Rep. 2016;6:35869.CrossRef
17.
go back to reference Bangalore S, Guo Y, Samadashvili Z, Blecker S, Hannan EL. Revascularization in patients with multivessel coronary artery disease and severe left ventricular systolic dysfunction: everolimus-eluting stents versus coronary artery bypass graft surgery. Circulation. 2016;133(22):2132–40.CrossRef Bangalore S, Guo Y, Samadashvili Z, Blecker S, Hannan EL. Revascularization in patients with multivessel coronary artery disease and severe left ventricular systolic dysfunction: everolimus-eluting stents versus coronary artery bypass graft surgery. Circulation. 2016;133(22):2132–40.CrossRef
18.
go back to reference Bundhun PK, Wu ZJ, Chen MH. Coronary artery bypass surgery compared with percutaneous coronary interventions in patients with insulin-treated type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials. Cardiovasc Diabetol. 2016;15:2.CrossRef Bundhun PK, Wu ZJ, Chen MH. Coronary artery bypass surgery compared with percutaneous coronary interventions in patients with insulin-treated type 2 diabetes mellitus: a systematic review and meta-analysis of 6 randomized controlled trials. Cardiovasc Diabetol. 2016;15:2.CrossRef
19.
go back to reference Bundhun PK, Sookharee Y, Bholee A, Huang F. Application of the SYNTAX score in interventional cardiology: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96(28):e7410.CrossRef Bundhun PK, Sookharee Y, Bholee A, Huang F. Application of the SYNTAX score in interventional cardiology: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96(28):e7410.CrossRef
Metadata
Title
Reassessing Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients with Type 2 Diabetes Mellitus: A Brief Updated Analytical Report (2015–2017)
Authors
Xia Dai
Zu-chun Luo
Lu Zhai
Wen-piao Zhao
Feng Huang
Publication date
01-10-2018
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 5/2018
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-018-0504-3

Other articles of this Issue 5/2018

Diabetes Therapy 5/2018 Go to the issue