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

Abstract

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.

The effect of coronary revascularization treatment timing on mortality in patients with stable ischemic heart disease in British Columbia

“…Similar findings were recently reported by Mehaffey and colleagues using contemporary CABG and PCI techniques in Medicare patients. [27] Our findings are consistent with those of a recent systematic review [28]…”

“…Similar findings were recently reported by Mehaffey and colleagues using contemporary CABG and PCI techniques in Medicare patients. [27] Our findings are consistent with those of a recent systematic review[28] included 23 studies comparing CABG with PCI. CABG was associated with better survival during follow-up in 17 studies and no significant difference between treatments in six, with no study favouring PCI.…”

Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery

“…A number of randomized studies (RCT) comparing CABG against PCI have demonstrated improved outcomes of CABG in patients with diabetes and high disease burden [ 4 , 5 , 6 ] without evidence for higher periprocedural mortality. Compared to PCI, CABG significantly improved long-term outcomes [ 7 , 8 , 9 ] likely due to a new blood supply route that is less affected by diffuse disease [ 10 ]. In the 5-year SYNTAX trial analysis, Kaplan–Meier estimates of myocardial infraction (CABG, 3.8%; PCI, 9.7%; p < 0.0001), repeat revascularisation (CABG, 13.7%; PCI, 25.9%; p < 0.0001), and major adverse cardiac and cerebrovascular events (CABG, 26.9%; PCI, 37.3%; p < 0.0001) were significantly higher in the PCI group compared to the CABG group [ 8 ].…”

Cardiac Surgery 2022 Reviewed

“…We therefore systematically searched the literature for registry studies comparing CABG and PCI in chronic CAD in which the region can be identified. 13 We found 22 studies, of which 19 were propensity risk–adjusted, from around the world. The great majority of these studies (74%) demonstrated a significant advantage in long-term mortality and major adverse cardiovascular event for CABG over PCI.…”