Show simple item record

dc.contributor.authorAriyaratne, T.
dc.contributor.authorAdemi, Z.
dc.contributor.authorYap, C.
dc.contributor.authorBillah, B.
dc.contributor.authorRosenfeldt, F.
dc.contributor.authorYan, B.
dc.contributor.authorReid, Christopher
dc.identifier.citationAriyaratne, T. and Ademi, Z. and Yap, C. and Billah, B. and Rosenfeldt, F. and Yan, B. and Reid, C. 2014. Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis. International Journal of Cardiology. 176 (2): pp. 346-353.

© 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.

dc.publisherElsevier Ireland Ltd
dc.titleProlonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis
dc.typeJournal Article
dcterms.source.titleInternational Journal of Cardiology
curtin.departmentDepartment of Health Policy and Management
curtin.accessStatusFulltext not available

Files in this item


There are no files associated with this item.

This item appears in the following Collection(s)

Show simple item record