Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis
MetadataShow full item record
© 2014 Elsevier Ireland Ltd. All rights reserved. Background: Currently, the appropriateness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for patients with diabetes (DM) and multi-vessel disease (MVD) is uncertain due to limited evidence from few randomised controlled trials (RCTs). We aimed to compare the clinical effectiveness of CABG versus PCI-DES in DM-MVD patients using an evidence-based approach. Methods: A systematic review and meta-analyses were conducted to compare the risk of all-cause mortality, myocardial infarction (MI), repeat revascularisation, cerebrovascular events (CVE), and major adverse cardiac or cerebrovascular events (MACCE). Results: A total of 1,837 and 3,052DM-MVD patientswere pooled fromfour RCTs (FREEDOM, SYNTAX,VA CARDS, and CARDia) and five non-randomised studies. At mean follow-up of 3 years, CABG comparedwith PCI-DES was associated with a lower risk of all-cause mortality and MI in RCTs. By contrast, no significant differences were observed in the mean 3.5-year risk of all-cause mortality and MI in non-randomised trials. However, the risk of repeat revascularisations following PCI-DES compared with CABG was 2.3 (95% CI = 1.8-2.8) and 3.0 (2.3- 4.2)-folds higher in RCTs and non-randomised trials, respectively. Accordingly, the risk of MACCE at 3 years following CABG compared with PCI-DES was lower in both RCTs and non-randomised trials [0.65 (: 0.55-0.77); and 0.77 (0.60-0.98), respectively]. Conclusions: Based on our pooled results, we recommend CABG compared with PCI-DES for patients with DM-MVD. Although non-randomised trials suggest no additional survival-, MI-, and CVE- benefit from CABG over PCI-DES, these results should be interpreted with care.
Showing items related by title, author, creator and subject.
Shields, L.; Zhou, Huaqiong; Pratt, J.; Taylor, M.; Hunter, J.; Pascoe, E. (2012)Background: This is an update of the Cochrane systematic review of family-centred care published in 2007 (Shields 2007). Family-centred care (FCC) is a widely used model in paediatrics, is thought to be the best way to ...
Watson, Hunna J (2007)It is of crucial importance to identify and disseminate effective treatments for paediatric obsessive-compulsive disorder (OCD). OCD is time-consuming and distressing, and can substantially disable functioning at school, ...
Comparison of the Safety and Efficacy of On-Pump (ONCAB) versus Off-Pump (OPCAB) Coronary Artery Bypass Graft Surgery in the Elderly: A Review of the ANZSCTS databaseDhurandhar, V.; Saxena, A.; Parikh, R.; Vallely, M.; Wilson, M.; Butcher, J.; Black, D.; Tran, L.; Reid, Christopher; Bannon, P. (2015)Background: The elderly population (age >70 years) incurs greater mortality and morbidity following CABG. OPCAB may mitigate these otucomes. A retrospective analysis of the results of OPCAB in this population was performed. ...