A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome

Kirov, Hristo; Caldonazo, Túlio; Rahouma, Mohamed; Robinson, N. Bryce; Demetres, Michelle; Serruys, Patrick W.; Biondi‐Zoccai, Giuseppe; Gaudino, Mario; Doenst, Torsten

doi:10.1038/s41598-022-09158-0

Cited by 9 publications

(8 citation statements)

References 34 publications

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“…There is an ongoing debate whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) provide better results for the treatment of coronary artery disease (CAD) [1][2][3] . A recent patient-level meta-analysis of all prospective randomized trials performed between 1996 and 2019 demonstrated a significant survival advantage for CABG after 5 years 4 , which appears to be greatest if anatomical complexity of CAD is high.…”

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confidence: 99%

Comparing CABG and PCI across the globe based on current regional registry evidence

Caldonazo

Kirov

Riedel

et al. 2022

Sci Rep

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There is an ongoing debate whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) provide better results for the treatment of coronary artery disease (CAD). We aimed to evaluate the impact of CABG or PCI on long-term survival based on local reports from different regions in the world. We systematically searched MEDLINE selecting studies that compared outcomes for CABG or PCI as a treatment for CAD in the last 10 years. Reports without all-cause mortality, multi-national cohorts, hybrid revascularization populations were excluded. Qualifying studies were statistically compared, and their geographic location visualized on a world map. From 5126 studies, one randomized and twenty-two observational studies (19 risk-adjusted) met the inclusion criteria. The mean follow-up was 4.7 ± 7 years and 18 different countries were included. In 17 studies, CABG was associated with better survival during follow-up, six studies showed no significant difference, and no study favored PCI. Periprocedural mortality was not different in seven, lower with PCI in one, lower with CABG in three and not reported in 12 studies. In regional registry-type comparisons, CABG is associated with better long-term survival compared to PCI in most regions of the world without evidence for higher periprocedural mortality.

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confidence: 99%

Comparing CABG and PCI across the globe based on current regional registry evidence

Caldonazo

Kirov

Riedel

et al. 2022

Sci Rep

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“…The comparative investigations of CABG and PCI in 2022 presented again some studies suggesting equal outcomes between PCI and CABG, specifically with non-ST elevation myocardial infarction. 16 Our global review and the most recently appearing publications, however, broadly support superiority of CABG over PCI in properly selected patients. For instance, an Israeli analysis comparing CABG and PCI in patients with acute coronary syndrome demonstrated in 2022 survival advantages for CABG in diabetic patients 17 ( Fig.…”

Section: Surgical Treatment Of Coronary Artery Diseasementioning

confidence: 85%

Cardiac Surgery 2022 Reviewed

Doenst,

Schneider,

Caldonazo

et al. 2023

Thorac Cardiovasc Surg

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PubMed displayed almost 37,000 hits for the search term “cardiac surgery AND 2022.” As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

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“…We conducted a meta-analysis of reconstructed time-to-event data with studies comparing CABG and PCI in octogenarians with LM or multi-vessel disease. 18 CABG was associated with lower late mortality and lower risk of MI and repeat revascularization compared with PCI. 18 A landmark analyses confirmed the survival advantage of CABG over PCI after 21.5 months of follow-up but in this situation it indeed suggested an advantage of PCI over CABG in the first 30-days (and comparable survival from 1 to 21.5 months, Fig.…”

Section: Surgical Treatment Of Coronary Artery Diseasementioning

confidence: 88%

Cardiac Surgery 2023 Reviewed

Kirov,

Caldonazo,

Mukharyamov

et al. 2024

Thorac Cardiovasc Surg

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We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term “cardiac surgery AND 2023.” We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.

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A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome

Cited by 9 publications

References 34 publications

Comparing CABG and PCI across the globe based on current regional registry evidence

Comparing CABG and PCI across the globe based on current regional registry evidence

Cardiac Surgery 2022 Reviewed

Cardiac Surgery 2023 Reviewed

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