Carvalho Pedro E P, Veiga Thiago M A, Machado Felipe S L, Porto Gabriel V, Pirez Jacqueline, Rivera Manuel, Melo Pedro C, Braghiroli Joao, Cardoso Rhanderson
Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Department of Medicine, Cesumar University, Maringa, Brazil.
J Card Surg. 2022 Dec;37(12):4646-4653. doi: 10.1111/jocs.17046. Epub 2022 Oct 19.
The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established.
To perform a meta-analysis evaluating the long-term outcomes after PCI with drug-eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD.
MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long-term effects of these interventions, we restricted this analysis to studies with a minimum follow-up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations.
Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all-cause mortality (RR: 1.21; 95% CI: 0.86-1.71; p = .27; I = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76-2.18; p = .34; I = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61-1.45; p = .79; I = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18-0.94; p = .04; I = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44-2.75; p < .001; I = 0%). The risk of the composite outcome of all-cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09-1.56; p = .004; I = 0%).
In this meta-analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG.
在患有糖尿病且左主干冠状动脉疾病（LMCAD）无保护的患者中，经皮冠状动脉介入治疗（PCI）相对于冠状动脉旁路移植术（CABG）的疗效和安全性尚未完全明确。
进行一项荟萃分析，评估在患有糖尿病且左主干冠状动脉疾病无保护的患者中，与冠状动脉旁路移植术相比，药物洗脱支架（DES）PCI术后的长期结局。
检索MEDLINE、Cochrane和Embase数据库，查找关于糖尿病患者无保护左主干冠状动脉疾病中DES PCI与冠状动脉旁路移植术术后结局的随机对照试验（RCT）。为评估这些干预措施的长期效果，我们将分析限制在最短随访期为3年的研究。采用随机效应模型汇总风险比（RR）及95%置信区间（CI）。根据Cochrane推荐进行质量评估和偏倚风险分析。
纳入4项RCT，共1080例患者，其中553例（51.2%）接受了PCI。在全因死亡率（RR：1.21；95%CI：0.86 - 1.71；p = 0.27；I² = 28%）、心血管死亡（RR 1.29；95%CI：0.76 - 2.18；p = 0.34；I² = 0%）或心肌梗死（MI）（RR：0.94；95%CI：0.61 - 1.45；p = 0.79；I² = 0%）的个体结局方面无差异。然而，与冠状动脉旁路移植术相比，PCI术后中风风险降低（RR：0.41；95%CI：0.18 - 0.94；p = 0.04；I² = 0%），而PCI组再次血运重建的风险更高（RR：1.99；95%CI：1.44 - 2.75；p < 0.001；I² = 0%）。与冠状动脉旁路移植术相比，PCI术后全因死亡率、心肌梗死、中风或再次血运重建的复合结局风险更高（RR：1.30；95%CI：1.09 - 1.56；p = 0.004；I² = 0%）。
在这项对1000多名患有糖尿病且左主干冠状动脉疾病无保护的患者进行至少3年随访的荟萃分析中，接受PCI治疗的患者再次血运重建的发生率更高，而接受冠状动脉旁路移植术治疗的患者中风风险更高。
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