Meta-analysis
Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With and Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials
- Pooled individual patient data analysis of 4 randomised trials
- subgroup analysis by diabetes status
Authors' conclusion
Compared with CABG, PCI resulted in no difference in the risk of death and a lower risk of early stroke regardless of diabetes status, and a higher risk of spontaneous MI and repeat coronary revascularization, with larger late absolute excess risks in patients with diabetes.
Study context
- Population
- Patients with left main disease, with and without DM, considered suitable for either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)
- Participants
- 4,393 patients · 4 RCTs
- Comparison
- PCI vs CABG
Pooled result
As reported in the abstract
All-cause mortality by DM status · 5 years
PCI vs CABGHazard ratio (95% CI)
DM: 84/563 [15.3%] vs 74/541 [14.1%]
1.11(0.82–1.52)
no DM: 155/1634 [9.7%] vs 142/1655 [8.9%]
1.08(0.86–1.36)
Further pooled results
5-year outcomes, DM vs no DM
- Death: 158/1104 [14.7%] vs 297/3289 [9.3%]
- P < 0.001
- Spontaneous myocardial infarction (MI): 67/1104 [6.7%] vs 114/3289 [3.7%]
- P < 0.001
- Repeat revascularization: 189/1104 [18.5%] vs 410/3289 [13.2%]
- P < 0.001
Stroke within 1 year
- Lower with PCI vs CABG in the entire population, no heterogeneity by DM
- PintHR=0.51
Spontaneous MI, PCI vs CABG, by DM · 5 years
- DM: 45/563 [8.9%] vs 22/541 [4.4%]
- No DM: 82/1634 [5.3%] vs 32/1655 [2.1%]
- interaction P (PintHR)=0.47
Repeat revascularization, PCI vs CABG, by DM · 5 years
- DM: 127/563 [24.5%] vs 62/541 [12.4%]
- No DM: 254/1634 [16.3%] vs 156/1655 [10.1%]
- interaction P (PintHR)=0.18
Absolute risk difference beyond 1 year (spontaneous MI; repeat revascularization)
- DM: 4.9% and 9.9%
- No DM: 2.1% and 4.3%
- PintARD=0.047 and 0.016
Original publication
Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With and Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials. Circulation. Published 11 March 2024. doi:10.1161/circulationaha.123.065571
Summarised from the published abstract; every number is checked against it