Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Clinical Trials

Background:

• Randomized trials comparing percutaneous coronary intervention (PCI) with stenting and coronary artery bypass grafting (CABG) for multivessel coronary artery disease are often underpowered to assess safety endpoints.
• Pooling data from multiple trials enhances statistical power for evaluating treatment effects, especially in high-risk subgroups.

Purpose of the Study:

• To compare the long-term safety and efficacy of PCI with stenting versus CABG in patients with multivessel coronary artery disease.
• To assess the incidence of death, stroke, myocardial infarction, and repeat revascularization at 5 years post-intervention.

Main Methods:

• A pooled analysis of 3051 patients from 4 randomized controlled trials was conducted.
• The study evaluated the composite endpoint of death, stroke, or myocardial infarction, and secondary endpoints including major adverse cardiac and cerebrovascular events and repeat revascularization.
• Treatment effect heterogeneity was examined in patient subgroups, including diabetics and those with 3-vessel disease.

Main Results:

• At 5 years, the cumulative incidence of death, myocardial infarction, and stroke was similar between PCI with stenting and CABG groups (16.7% vs. 16.9%).
• Repeat revascularization occurred significantly more often after PCI than CABG (29.0% vs. 7.9%).
• Major adverse cardiac and cerebrovascular events were significantly higher in the PCI group compared to the CABG group (39.2% vs. 23.0%).

Conclusions:

• PCI with stenting demonstrates a long-term safety profile comparable to CABG for multivessel coronary artery disease.
• CABG is associated with significantly lower rates of repeat revascularization and overall major adverse cardiac and cerebrovascular events at 5 years.