Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention and Long-term Mortality and Morbidity in Multivessel Disease

Abstract

IMPORTANCE Recent trials of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) for multivessel disease were not designed to detect a difference in mortality and therefore were underpowered for this outcome. Consequently, the comparative effects of these 2 revascularization methods on long-term mortality are still unclear. In the absence of solid evidence for mortality difference, PCI is oftentimes preferred over CABG in these patients, given its less invasive nature. OBJECTIVES To determine the comparative effects of CABG vs PCI on long-term mortality and morbidity by performing a meta-analysis of all randomized clinical trials of the current era that compared the 2 treatment techniques in patients with multivessel disease. DATA SOURCES A systematic literature search was conducted for all randomized clinical trials directly comparing CABG with PCI. STUDY SELECTION To reflect current practice, we included randomized trials with 1 or more arterial grafts used in at least 90%, and 1 or more stents used in at least 70% of the cases that reported outcomes in patients with multivessel disease. DATA EXTRACTION Numbers of events at the longest possible follow-up and sample sizes were extracted. DATA SYNTHESIS A total of 6 randomized trials enrolling a total of 6055 patients were included, with a weighted average follow-up of 4.1 years. There was a significant reduction in total mortality with CABG compared with PCI (I 2 = 0%; risk ratio [RR], 0.73 [95% CI, 0.62-0.86]) (P < .001). There were also significant reductions in myocardial infarction (I 2 = 8.02%; RR, 0.58 [95% CI, 0.48-0.72]) (P < .001) and repeat revascularization (I 2 = 75.6%; RR, 0.29 [95% CI, 0.21-0.41]) (P < .001) with CABG. There was a trend toward excess strokes with CABG (I 2 = 24.9%; RR, 1.36 [95% CI, 0.99-1.86]), but this was not statistically significant (P = .06). For reduction in total mortality, there was no heterogeneity between trials that were limited to and not limited to patients with diabetes or whether stents were drug eluting or not. Owing to lack of individual patient-level data, additional subgroup analyses could not be performed. CONCLUSIONS AND RELEVANCE In patients with multivessel coronary disease, compared with PCI, CABG leads to an unequivocal reduction in long-term mortality and myocardial infarctions and to reductions in repeat revascularizations, regardless of whether patients are diabetic or not. These findings have implications for management of such patients.

Correlation between clinical and socioeconomic characteristics and perceived health status of patients with heart failure

“…This data differs from the data in the literature, where outpatients are commonly stratified in class II and III, and FC I patients rarely have any health monitoring for the slight and sporadic symptoms of the heart disease ( ALMEIDA et al, 2013;SIPAHI et al, 2014).…”

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

“…However, this extraordinary reduction should be viewed in wider perspective; indeed, although not directly the objective of the current investigation, “no‐touch” OPCAB might offer the long‐term survival benefit of CABG over PCI,2, 35 together with similar or lower than PCI 30‐day stroke rates 36, 37. The discussion about potential shortcomings of CABG as compared to PCI was fueled after the first large industry‐funded trial3 found significantly higher rates of major adverse cardiac and cerebrovascular events in the PCI group (17.8% versus 12.4% for CABG; P =0.002), in large part because of an increased rate of repeat revascularization (13.5% versus 5.9%); however, at 12 months, strokes were 4‐fold more likely to occur with CABG (2.2% versus 0.6% with PCI; P =0.003).…”

International Validation of the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention in Post‐MI Patients: A Collaborative Analysis of the Chronic Kidney Disease Prognosis Consortium and the Risk Validation Scientific Committee

“…Specifically, patients with cardiovascular disease may incorrectly self‐report smoking status since they are under the pressure to quit smoking 38. For CABG, several trials have shown its survival benefits compared with percutaneous revascularization or medical treatments in patients with severe coronary heart disease 39, 40, 41. Thus, the prognostic value of CABG may depend on patient characteristics.…”