Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data

Abstract

None.

2018 ESC/EACTS Guidelines on myocardial revascularization

“…153 In a collaborative, individual patient data pooled analysis of 11 518 patients with multivessel or LM disease randomized to CABG or PCI with stents, all-cause death was significantly different after CABG (9.2%) and PCI (11.2%) (P = 0.0038), which was evident in patients with diabetes (10.7 vs. 15.7%, respectively; P = 0.0001) but not in patients without diabetes (8.4 vs. 8.7%, respectively; P = 0.81) (P interaction = 0.0077). 124 Similar results were found in the subgroup of 7040 patients with multivessel disease (P interaction = 0.0453), while the interaction with diabetes was not significant in the 4478 patients with LM disease (P interaction = 0.13).…”

“…[121][122][123] In subsequent RCTs, the interaction of the strata of SYNTAX score with the effect of the randomized treatment was less pronounced and did not reach statistical significance. [105][106][107] However, in a recent collaborative individual patient pooled analysis of randomized trials including 11 518 patients, 124 the test for trend across the ordered tertiles of the SYNTAX score of the SYNTAX study was positive at P = 0.0011 (unpublished analysis), confirming the strata of the SYNTAX score as an effect modifier to be considered. There is concern about bias and inter-individual variability in calculating the SYNTAX score.…”

“…124 The primary outcome was all-cause mortality. In the overall cohort, CABG was associated with a significant survival benefit during a mean follow-up of 3.8 ± 1.4 years (5 year all-cause mortality 11.2% after PCI vs. 9.2% after CABG; HR 1.20, 95% CI 1.06-1.37, P = 0.0038).…”

“…105 At a median follow-up of 4.6 Consistent with findings in the overall cohort (see section 5.3.3), the collaborative individual patient pooled analysis found that in 7040 patients with multivessel disease, those assigned to CABG had significantly lower 5 year all-cause mortality than those assigned to PCI (PCI 11.5 vs. CABG 8.9%; HR 1.28, 95% CI 1.09-1.49, P = 0.0019). 124 Outcomes for the endpoint all-cause mortality were modified by two variables, diabetes and disease complexity, as assessed by the SYNTAX score. Compared with patients without diabetes (8.7 vs. 8.0%; HR 1.08, 95% CI 0.86-1.36, P = 0.49), mortality was higher after PCI than CABG in patients with diabetes (15.5 vs. 10.0%; HR 1.48, 95% CI 1.19-1.84, P = 0.0004, P interaction = 0.045).…”

“…Consistent results were also obtained for patients with multivessel CAD in the recent individual patient-level meta-analysis. 124 Thus, the previous class III recommendation for PCI in multivessel CAD and intermediate-tohigh complexity was maintained.…”