Risk of adverse outcomes up with PCI in adults with diabetes

(HealthDay)—For adults with diabetes and multivessel or left main coronary artery disease, percutaneous coronary intervention (PCI) is associated with increased likelihood of a composite outcome compared with coronary artery bypass grafting (CABG), according to a review and meta-analysis published in the Nov. 18 issue of the Annals of Internal Medicine.

Benny Tu, M.B.B.S., from the University of Queensland in Brisbane, Australia, and colleagues compared long-term outcomes between the revascularization techniques of PCI and CABG in patients with diabetes. Data were obtained from 40 studies involving adults with diabetes with multivessel or left main coronary artery disease.

The researchers found that the likelihood of the primary outcome (composite of all-cause mortality, nonfatal myocardial infarction, and stroke) increased with PCI (odds ratio, 1.33; 95 percent credible interval [CrI], 1.01 to 1.65). Mortality was increased significantly with PCI (odds ratio, 1.44; 95 percent CrI, 1.05 to 1.91), while there was no change in the number of myocardial infarctions (odds ratio, 1.33; 95 percent CrI, 0.86 to 1.95) and the likelihood of stroke decreased (odds ratio, 0.56; 95 percent CrI, 0.36 to 0.88).

"Because of residual uncertainties and increased risk for stroke with CABG, clinical judgment is required when choosing a revascularization technique in patients with diabetes," the authors write.