Author + information
- Mahin Khan1,
- Waqas Ahmed2,
- Malalai Manan3,
- Ihab Hamzeh4,
- Salim Virani5,
- Nasser Lakkis6 and
- Mahboob Alam4
- 1McLaren Regional Medical Center, Flint, Michigan, United States
- 2Nishtar Medical College, Multan, Pakistan
- 3King Edward Medical University, Lahore, Pakistan
- 4Baylor College of Medicine, Houston, Texas, United States
- 5Baylor College of Medicine, Michael E DeBakey, Houston, Texas, United States
- 6Baylor College of Medicine, Houston, Texas, United States
Improved Percutaneous Coronary Intervention (PCI) techniques for Unprotected Left Main (ULM) disease have led to comparable outcomes to Coronary Artery Bypass Grafting (CABG). Data pertaining specifically to the optimal revascularization strategy for ULM lesions in diabetics is scarce.
A comprehensive literature search to June 2017 identified 7 studies (1 Randomized, 6 Observational) with 4193 patients (PCI=2215, CABG=1978). We performed aggregate data meta-analyses of clinical outcomes (all-cause mortality, cardiac mortality, repeat revascularization and MACCE) comparing PCI and CABG in patients with diabetes and ULM disease. Odds Ratios (OR) and 95% confidence intervals (CI) were estimated using random-effects model.
In our analysis, for a median follow-up of ≥36 months, the composite outcome of death, MI or stroke was lower in diabetic patients with ULM disease undergoing PCI compared to CABG (OR 0.75; 95% CI 0.59-0.96).There was no statistical difference in all-cause mortality (OR 0.86; 95% CI 0.64- 1.15). PCI had lower rates of stroke but higher rates of repeat revascularization and MACCE (OR 1.60; 95 % CI 1.34- 1.92) compared to CABG (Table 1. Outcomes of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Unprotected Left Main Disease in Diabetics).
|Outcomes||Studies||Patients||Event Rate||OR (Random) 95% CI|
|Death||7||4193||256/2215 (11.6)||256/1978 (12.9)||0.86 [0.64, 1.15]|
|Stroke||4||1651||16/940 (1.7)||42/711 (5.9)||0.34 [0.16, 0.76]|
|Repeat Revascularization||7||4193||353/2215 (15.9)||106/1978 (5.4)||3.52 [2.34, 5.29]|
|Myocardial Infarction (MI)||4||1778||66/993 (6.7)||36/785 (4.6)||1.35 [0.53, 3.43]|
|Composite of Death, MI and Stroke||3||2415||137/1222 (11.2)||172/1193 (14.4)||0.75 [0.59, 0.96]|
|MACCE†||4||3186||481/1772 (27.1)||289/1464 (19.7)||1.60 [1.34, 1.92]|
In our analysis, for diabetic patients with ULM disease, PCI and CABG had equivalent mortality, with lower composite hard outcomes of Death, MI and Stroke, mostly driven by decreased stroke rates with PCI. This study is consistent with other similar studies showing the increased incidence of repeat revascularization with PCI compared to CABG, tilting MACCE in favor of CABG.
CORONARY: PCI Outcomes