Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus: Cumulative Meta-analysis

Previous meta-analyses showed that coronary artery bypass grafting (CABG) has lower all-cause mortality than percutaneous coronary intervention (PCI) for the management of coronary heart disease (CHD), but the long-term outcomes were not analyzed thoroughly in patients with type 2 diabetes mellitus (T2DM). To perform a meta-analysis of randomized controlled trials (RCTs) to explore the long-term effectiveness between CABG and PCI in patients with T2DM and study the temporal trends using a cumulative meta-analysis. PubMed, Embase, Cochrane library, and Clinical Trials Registry for eligible RCTs published up to September 2020. The outcomes were all-cause death, cardiac death, myocardial infarction, repeat revascularization, and stroke. Nine RCTs and 4566 patients were included. CABG resulted in better outcomes than PCI in terms of all-cause death (RR = 1.41, 95%CI: 1.22-1.63, p < 0.001), cardiac death (RR = 1.56, 95%CI: 1.25-1.95, p < 0.001), and repeat revascularization (RR = 2.68, 95%CI: 1.86-3.85, p < 0.001), but with difference regarding the occurrence of myocardial infarction (RR = 1.20, 95%CI: 0.78-1.85, p = 0.414), while PCI was associated with better outcomes in terms of stroke occurrence (RR = 0.51, 95%CI: 0.34-0.77, p = 0.001). The cumulative meta-analysis for all-cause death showed that the differences between CABG and PCI started to be significant at 3 years of follow-up, while the difference became significant at 5 years for cardiac death. In patients with CHD and T2DM, CABG results in better outcomes than PCI in terms of all-cause death, cardiac mortality, and repeat revascularization, while PCI had better outcomes in terms of stroke. The differences are mainly observed over the long-term follow-up.