Meta-Analysis of Studies Comparing Coronary Artery Bypass Grafting With Drug-Eluting Stenting in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease

This meta-analysis was undertaken to assess the efficacy and safety of coronary artery bypass grafting (CABG) compared to drug-eluting stenting (DES) in patients with diabetes mellitus and multivessel coronary artery disease (CAD). CABG has been the preferred revascularization strategy in patients with diabetes compared to DES. Drug-eluting stents reduce the rate of target vessel revascularization compared to bare-metal stents. The ideal revascularization strategy for patients with diabetes with multivessel CAD in the DES era is unknown. A search of published reports was performed to identify clinical studies comparing CABG with DES in patients with diabetes with multivessel CAD with a minimum follow-up of 1 year. Five studies including 1,543 patients with diabetes (757 who underwent CABG and 786 who underwent DES) met the selection criteria. The mean follow-up period was 18 months (range 12 to 36). Compared to DES, CABG was associated with a lower risk for major adverse cardiac events (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.36 to 0.65), driven mainly by a lower risk for repeat revascularization (OR 0.18, 95% CI 0.11 to 0.30), despite having a higher percentage of triple-vessel disease. There was no significant difference in death (OR 0.85, 95% CI 0.52 to 1.39) or myocardial infarction (OR 0.82, 95% CI 0.41 to 1.61). Patients in the CABG group had a higher risk for cerebrovascular events (OR 2.15, 95% CI 0.99 to 4.68). In conclusion, PCI with DES is safe and may represent a viable alternative to CABG for selected patients with diabetes with multivessel CAD.