Coronary Revascularization for Patients with Diabetes Mellitus

Abstract

Objective:This systematic review and meta-analysis aims to review the contemporary literature comparing CABG and PCI in diabetic patients providing an up-to-date perspective on the differences between the interventions.Background:Diabetes is common and diabetic patients are at a 2-to-4-fold increased risk of developing coronary artery disease. Approximately 75% of diabetic patients die of cardiovascular disease. Previous literature has identified CABG as superior to PCI for revascularization in diabetic patients with complex coronary artery diseas.Methods:PubMed and Medline were systematically searched for articles published from January 1, 2015 to April 15, 2021. This systematic review included all retrospective, prospective, and randomized trial studies comparing CABG and PCI in diabetic patients. 1552 abstracts were reviewed and 25 studies were included in this review. The data was analyzed using the RevMan 5.4 software.Results:Diabetic patients undergoing CABG experienced significantly reduced rates of 5-year mortality, major adverse cardiovascular and cerebrovascular events, myocardial infarction, and required repeat revascularization. Patients who underwent PCI experienced improved rates of stroke that trended toward significance.Conclusions:Previous literature regarding coronary revascularization in diabetic patients has consistently demonstrated superior outcomes for patients undergoing CABG over PCI. The development of 1st and 2nd generation DES have narrowed the gap between CABG and PCI, but CABG continues to be superior. Continued investigation with large randomized trials and retrospective studies including long term follow-up comparing CABG and 2nd generation DES is necessary to confirm the optimal intervention for diabetic patients.

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients With Three Vessel Coronary Artery Disease

“…In the setting of complex three-vessel disease (TVD) or multivessel disease, diabetic patients, and those with left ventricular dysfunction, CABG confers an advantage over PCI. These trends have been demonstrated in numerous retrospective studies, randomized control trials, and are reflected in international guidelines given the evidence supporting each 7,11–15…”

“…These trends have been demonstrated in numerous retrospective studies, randomized control trials, and are reflected in international guidelines given the evidence supporting each. 7,[11][12][13][14][15] In the case of TVD, CABG has demonstrated favorable outcomes over PCI. Numerous studies have compared these 2 interventions with rates of mortality, repeat revascularization, and MI favoring CABG.…”

Type two diabetes mellitus and microvascular complications in patients with coronary artery disease: prevalence, prognosis and choice of antithrombotic therapy

“…одним из дискуссионных вопросов остается выбор плановой реваскуляризации у больных Сд 2 типа и ибС при наличии показаний. в одном из последних мета-анализов 25 наблюдательных и рки было вновь определено, что у пациентов с Сд 2 типа, которым было выполнено кш, значительно снижался ор 5-летней общей смертности, больших неблагоприятных сердечнососудистых и цереброваскулярных событий, им и потребности в повторной реваскуляризации [64]. у больных Сд 2 типа, перенёсших плановое чкв, имелась лишь тенденция снижения риска инсульта.…”