Date of Award

8-15-2021

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

First Advisor

Dipu Patel

Abstract

Objectives: This systemic review is conducted to compare between Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) in the revascularization strategy of patients with diabetes mellitus (DM) and multivessel coronary artery disease (CAD) based on clinical outcomes.

Background: Diabetes mellitus approached epidemic proportions globally and was recognized as a risk factor of aggressive and multivessel CAD [1,2]. The controversy over the optimal revascularization strategy for patients with DM and multivessel CAD has been hotly debated for more than 10 years. Numerous studies and data analysis were conducted to compare between PCI and CABG based on clinical outcomes of DM patients after procedure. Those studies enormously contributed to the improvement in long-term survival rate, major adverse cardiac and cerebrovascular events (MACCE) rate, quality of life, and cost-effectiveness.

Methods: This systemic review utilized PubMed, ScienceDirect, and Google Scholar as search engines. A total of 39 articles were recruited. Among them, 26 articles were analyzed and organized based on timeline, where data about long-term survival rate, the MACCE rate, quality of life, complications after both procedures were extracted and conclusions were made.

Results: In the bare-metal stent era, CABG showed better outcomes compared with PCI for both short- and long-term clinical outcomes. Patients who underwent PCI had significantly higher mortality rate, MACCE rate, and repeated revascularization rate compared with patients who underwent CABG. However, with the advent of drug-eluting stent, PCI became comparable to CABG especially in short-term outcomes. Nonetheless, CABG still surpassed PCI in the long run with smaller mortality, myocardial infarction (MI) rate, and repeated revascularization risk at five-year follow-up. Hence, CABG remains the revascularization strategy of choice for patients with DM and multivessel CAD.

Conclusion: Although patients who underwent CABG face higher risk of stroke compared to patients who underwent PCI, CABG outweighs PCI with the reduced mortality, MI rate and repeated revascularization rate, especially in long-term follow-up. Supposing the decision process depends on clinical judgment and accessibility to procedure, CABG should be preferable in patients with DM and multivessel CAD.

Identifier

SC 11.PAS.2021.Vu.D

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