CABG vs DES meta-analysis in diabetes mellitus

Coronary artery bypass grafting versus drug-eluting stents in patients with severe coronary artery disease and diabetes mellitus: a systematic review and meta-analysis 
Journal of Diabetes, 06/11/2014  Evidence Based Medicine  Review Article

The authors performed a comprehensive meta–analysis to evaluate the comparative benefits of coronary artery bypass grafting versus drug–eluting stents in patients with diabetes mellitus and severe coronary artery disease. For patients with diabetes mellitus and severe coronary artery disease, CABG was superior to DES in that it significantly improve overall and MACCE–free survival rate and reduce incidences of myocardial infarction and repeat revascularization in the long–term follow–up, although it was associated with more perioperative risks and a higher incidence of stroke. Therefore, CABG should remain the gold standard for these patients.

Methods

• A comprehensive literature search of PubMed, Embase, and ScienceDirect was carried out.
• References and cited papers of relevant articles were also checked.

Results

• A total of 4 randomized controlled trials, 2 prospective registries and 11 retrospective studies were identified for this review.
• Pooled analysis demonstrated that DES was associated with lower all-cause mortality at 30-day.
• However, there was no significant difference between CABG and DES in mortality at 12-month and at maximum follow-up, DES was associated with lower overall and MACCE-free survival rate, higher incidences of myocardial infarction and repeat revascularization.
• CABG was associated with an increased risk of stroke.