Dataset Information

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta-analysis.

ABSTRACT: Previous meta-analyses showed that coronary artery bypass grafting (CABG) has lower all-cause mortality than percutaneous coronary intervention (PCI) for the management of coronary heart disease (CHD), but the long-term outcomes were not analyzed thoroughly in patients with type 2 diabetes mellitus (T2DM). To perform a meta-analysis of randomized controlled trials (RCTs) to explore the long-term effectiveness between CABG and PCI in patients with T2DM and study the temporal trends using a cumulative meta-analysis. PubMed, Embase, Cochrane library, and Clinical Trials Registry for eligible RCTs published up to September 2020. The outcomes were all-cause death, cardiac death, myocardial infarction, repeat revascularization, and stroke. Nine RCTs and 4566 patients were included. CABG resulted in better outcomes than PCI in terms of all-cause death (RR = 1.41, 95%CI: 1.22-1.63, p < 0.001), cardiac death (RR = 1.56, 95%CI: 1.25-1.95, p < 0.001), and repeat revascularization (RR = 2.68, 95%CI: 1.86-3.85, p < 0.001), but with difference regarding the occurrence of myocardial infarction (RR = 1.20, 95%CI: 0.78-1.85, p = 0.414), while PCI was associated with better outcomes in terms of stroke occurrence (RR = 0.51, 95%CI: 0.34-0.77, p = 0.001). The cumulative meta-analysis for all-cause death showed that the differences between CABG and PCI started to be significant at 3 years of follow-up, while the difference became significant at 5 years for cardiac death. In patients with CHD and T2DM, CABG results in better outcomes than PCI in terms of all-cause death, cardiac mortality, and repeat revascularization, while PCI had better outcomes in terms of stroke. The differences are mainly observed over the long-term follow-up.

SUBMITTER: Xie Q

PROVIDER: S-EPMC8259162 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BACKGROUND:The target of this study was to explore the outcomes of percutaneous coronary intervention (PCI) in diabetic versus non-diabetic patients with prior coronary artery bypass grafting (CABG) surgery. METHODS:Seven hundred and twenty four patients who had previously received CABG and had been treated using PCI combined with drug-eluting stents (DES) between 2009 and 2017 were selected for a retrospective study and allocated into either a diabetes mellitus (DM) or non-diabetes mellitus (No DM) group. A 1:1 propensity score-matched evaluation was conducted and risk adjusted for analysis. The primary outcomes were cardiac death, myocardial infarction, heart failure and revascularization, with a median follow-up duration of 5.13?years. RESULTS:After matching, two-, 5- and 8-year event rate of overall major adverse cardiac events (MACEs) were found to be higher in the DM group (No DM vs DM:15.3, 30.9, 38.5% vs 19.8, 37.8, 52.2%, respectively), although no significant difference was found in the event rate of overall MACEs (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.00 to 1.83 for DM vs No DM; P?=?0.052), cardiac death (HR: 0.94; 95% CI: 0.45 to 1.95; P?=?0.871), MI (HR: 1.49; 95% CI: 0.95 to 2.32; P?=?0.080), HF (HR: 1.54; 95% CI: 0.90 to 2.63 for; P?=?0.120) or revascularization (HR: 1.07; 95% CI: 0.72 to 1.59; P?=?0.747). Subgroup analysis of PCI in only the NCA showed MACEs (adjusted HR: 1.13; 95% CI: 0.85 to 1.49 for DM vs No DM; P?=?0.325), cardiac death (adjusted HR: 0.85; 95% CI: 0.41 to 1.78 for DM vs No DM; P?=?0.781), MI (adjusted HR: 1.32; 95% CI: 0.84 to 2.01 for DM vs No DM; P?=?0.069), HF (adjusted HR: 1.41; 95% CI: 0.87 to 2.27 for DM vs No DM; P?=?0.211) or repeated revascularization (adjusted HR: 0.93; 95% CI: 0.64 to 1.37 for DM vs No DM; P?=?0.836). CONCLUSIONS:Compared with non-diabetic patients with prior CABG, subsequent implantation of DES in the native coronary artery of diabetic patients resulted in apparently similar outcomes. TRIAL REGISTRATION:This study was not registered in an open access database.

Project description:Rationale & objectiveWe aimed to study the comparative effectiveness of percutaneous coronary intervention with drug-eluting stent and coronary artery bypass grafting in patients receiving dialysis.Study designThis was a retrospective observational cohort study.Setting & participantsThis population-based study identified patients receiving dialysis hospitalized for coronary revascularization between January 1, 2009 and December 31, 2015, in the Taiwan National Health Insurance Research Database.ExposuresPatients received percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting.OutcomesThe study outcomes were all-cause mortality, in-hospital mortality, and repeat revascularization.Analytical approachPropensity scores were used to match patients. Cox proportional hazards models and logistic regression models were constructed to examine associations between revascularization strategies and mortality. Interval Cox models were fitted to estimate time-varying hazards during different periods.ResultsA total of 1,840 propensity score-matched patients receiving dialysis were analyzed. Coronary artery bypass grafting was associated with higher in-hospital mortality (coronary artery bypass grafting vs percutaneous coronary intervention with drug-eluting stent; crude mortality rate 12.5% vs 3.3%; adjusted OR, 5.22; 95% CI, 3.42-7.97; P < 0.001) and longer hospitalization duration (median [IQR], 20 [14-30] days vs 3 [2-8] days; P < 0.001). After discharge, repeat revascularization, acute coronary syndrome, and repeat hospitalization all occurred more frequently in the percutaneous coronary intervention with drug-eluting stent group. Importantly, with a median follow-up of 2.8 years, coronary artery bypass grafting was significantly associated with a higher risk of all-cause overall mortality (adjusted HR, 1.19; 95% CI, 1.05-1.35; P = 0.006) in the multivariable Cox proportional hazard model. Sensitivity and subgroup analyses yielded consistent results.LimitationsThis was an observational study with mainly Asian ethnicity.ConclusionsPercutaneous coronary intervention with drug-eluting stent may be associated with better survival than coronary artery bypass grafting in patients receiving dialysis. Future studies are warranted to confirm this finding.

Dataset Information

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta-analysis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets