Coronary Revascularization in Diabetic Patients: A Systematic Review and Bayesian Network Meta-analysis

Tu, Benny, Rich, Ben, Labos, Christopher and Brophy, James M. (2014) Coronary Revascularization in Diabetic Patients: A Systematic Review and Bayesian Network Meta-analysis. Annals of Internal Medicine, 161 10: 724-732. doi:10.7326/M14-0808

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Author Tu, Benny
Rich, Ben
Labos, Christopher
Brophy, James M.
Title Coronary Revascularization in Diabetic Patients: A Systematic Review and Bayesian Network Meta-analysis
Journal name Annals of Internal Medicine   Check publisher's open access policy
ISSN 0003-4819
Publication date 2014-11
Sub-type Critical review of research, literature review, critical commentary
DOI 10.7326/M14-0808
Open Access Status
Volume 161
Issue 10
Start page 724
End page 732
Total pages 9
Place of publication Charlottesville, VA United States
Publisher Silverchair Information Systems
Collection year 2015
Language eng
Formatted abstract
Background: The optimal revascularization technique in diabetic patients is an important unresolved question.

Purpose: To compare long-term outcomes between the revascularization techniques of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).

Data Sources: English-language publications in PubMed, the Cochrane Central Register of Controlled Trials, Ovid, and EMBASE between 1 January 1990 and 1 June 2014.

Study Selection: Two investigators independently reviewed randomized, controlled trials comparing PCI (with drug-eluting or bare-metal stents) with CABG in adults with diabetes with multivessel or left main coronary artery disease.

Data Extraction: Study design, quality, patient characteristics, length of follow-up, and outcomes were extracted. For duplicate publications, outcomes were obtained from the publication with the longest follow-up.

Data Synthesis: 40 studies were combined using a Bayesian network meta-analysis that accounted for the variation in stent choice. The primary outcome, a composite of all-cause mortality, nonfatal myocardial infarction, and stroke, increased with PCI (odds ratio [OR], 1.33 [95% credible interval {CrI}, 1.01 to 1.65]). Percutaneous coronary intervention resulted in increased mortality (OR, 1.44 [CrI, 1.05 to 1.91]), no change in the number of myocardial infarctions (OR, 1.33 [CrI, 0.86 to 1.95]), and fewer strokes (OR, 0.56 [CrI, 0.36 to 0.88]).

Limitations: Study design and length of follow-up were heterogeneous, and results were driven primarily by a single study. Costs and nonvascular complications of the interventions were not examined.

Conclusion: Coronary artery bypass grafting seems to be the preferred revascularization technique in diabetics, especially if long-term survival is anticipated. However, because of residual uncertainties and increased risk for stroke with CABG, clinical judgment is required when choosing a revascularization technique in patients with diabetes.
Keyword Drug Eluting Stents
Artery Bypass Surgery
Bare Metal Stents
Multivessel Disease
Randomized Trials
Q-Index Code CX
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Non HERDC
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