Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement？

几研究证明了冠的动脉绕过接枝外科(CABG ) 在有糖尿病和多容器疾病的病人比经皮的冠的干预(一种总线标准) 优异。在一种总线标准上的 CABG 的这个优点是否被限制到要求胰岛素的糖尿病患者，是未知的。我们考察包括 8 个队和 4,786 个病人在糖尿病患者把 CABG 与一种总线标准作比较的出版文学。为所有原因死亡有更低的率(相对风险(RR ) ：0.78， 95% 信心间隔(CI ) ：0.62-0.99 ) ，并且为主要不利心脏、脑血管的事件(MACCE， RR：0.59， 95% CI：0.47-0.75 ) 为与一种总线标准相比的 CABG。死亡的合成结果，心肌的梗塞并且司烧在 CABG 和一种总线标准之间是类似的(RR：0.87， 95% CI：0.54-1.42 ) 。森林阴谋的视觉检查证明在大多数分析， RR 的点估计在要求组和非胰岛素要求组的胰岛素之间是类似的。在元回归上，在胰岛素要求和 revascularization 策略的地位之间没有相互作用(P &#x0003e；0.05 为所有) 。FREEDOM 试用的仍然未出版的分析上的介绍数据显示出类似的结果。因此在当前的时代， CABG 比有更低的死亡和 MACCE 率的一种总线标准优异，但是胰岛素要求的状态没从二 revascularization 策略在结果上有效果。

Several studies have shown that coronary artery bypass graft surgery （CABG） is superior to percutaneous coronary intervention （PCI） in patients with diabetes and multi-vessel disease. Whether this advantage of CABG over PCI is confined to diabetics who require insulin is unknown. We review the published literature comparing CABG with PCI in diabetics including 8 cohorts and 4,786 patients. There was a lower rate for all-cause mortality （Relative risk （RR）： 0.78, 95% confidence interval （CI）： 0.62-0.99）, and for major adverse cardiac and cerebrovascular events （MACCE, RR： 0.59, 95% CI： 0.47-0.75） for CABG compared to PCI. Composite outcome of mortality, myocardial infarction and stoke was similar between CABG and PCI （RR： 0.87, 95% CI： 0.54-1.42）. Visual inspection of the forest plots showed that in most analyses, the point estimates of the RR are similar between the insulin requiring group and non-insulin requiring group. On meta-regression, there was no interaction between status of insulin requirement and revascularization strategies （P 〉 0.05 for all）. The pre- sented data on the still unpublished analysis of the FREEDOM trial showed similar results. Thus, in the current era, CABG is superior to PCI with lower mortality and MACCE rates, but the state of insulin requirement had no effect on the outcomes from the two revascularization strategies.