Coronary artery bypass grafting (CABG) is the preferred revascularisation method for patients with diabetes and multivessel coronary artery disease, a new review has concluded.
While percutaneous coronary intervention (PCI) is increasingly preferred for many patient groups, there is still a clear superiority in terms of mortality in patients with diabetes, a pooled analysis of 11 randomised controlled trials published in The Lancet found.
Described as the largest analysis to date, involving more than 11,500 patients randomly assigned to having stents or to CABG, the review showed that the overall five-year all-cause mortality was significantly lower with CABG (9·2%) compared to PCI (11·2%), with a hazard ratio of 1·20 for PCI.
However, in subgroup analyses, CABG only had a mortality benefit over PCI in patients with multivessel disease and diabetes (10.0% vs 15.5%). No difference in mortality was seen in patients with multivessel disease without diabetes, nor in patients with left main disease
The mortality benefit of CABG over PCI increased with increasing lesion complexity, as assessed with the SYNTAX score.
The study authors said the comparative benefits of CABG and PCI had been strongly debated, especially in light of developments in stent technology. However they emphasised that their findings remained consistent in more recent trials that included more high risk patients and with the latest stent technology.
The presence of diabetes was an important modifier, … the benefit of CABG in patients with diabetes might be attributed to more effective revascularisation of diffuse, complex coronary disease,” they said.