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Published on: March 15, 2022
Risk of stroke with coronary artery bypass graft surgery compared with percutaneous coronary intervention
Tullio Palmerini1, Giuseppe Biondi-Zoccai, Letizia Bacchi Reggiani
1Istituto di Cardiologia, Policlinico S. Orsola, Bologna, Italy.
Insights
Coronary artery bypass graft (CABG) surgery is linked to a higher stroke risk than percutaneous coronary intervention (PCI) at 30 days and midterm follow-up. This finding is consistent across various extents of coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Epidemiology
Background:
- Previous randomized trials suggest a potential increase in stroke rates with CABG versus PCI.
- However, these studies often lacked sufficient power to reliably assess stroke risk differences.
Purpose of the Study:
- To compare the risk of stroke between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI).
- To investigate the influence of coronary artery disease extent on stroke risk in both procedures.
Main Methods:
- A meta-analysis of 19 randomized trials involving 10,944 patients comparing CABG and PCI.
- Primary endpoint: 30-day stroke rate. Secondary endpoint: midterm stroke rate.
- Analysis of interaction between revascularization type and coronary artery disease extent.
Main Results:
- The 30-day stroke rate was significantly higher after CABG (1.20%) compared to PCI (0.34%).
- Midterm follow-up also showed a higher stroke rate with CABG (1.83%) versus PCI (0.99%).
- The extent of coronary artery disease did not significantly alter the relative stroke risk increase associated with CABG.
Conclusions:
- Coronary revascularization using CABG is associated with an elevated risk of stroke at both 30 days and midterm follow-up compared to PCI.
- These findings were consistent even when analyzing data from observational studies.
Objectives:
This study sought to determine whether coronary artery bypass graft (CABG) surgery is associated with an increased risk of stroke compared with percutaneous coronary intervention (PCI).
Background:
Some, but not all, randomized trials have reported increased rates of stroke with CABG compared with PCI. However, all these studies were powered insufficiently to examine differences in the risk of stroke reliably.
Methods:
We performed a meta-analysis of 19 trials in which 10,944 patients were randomized to CABG versus PCI. The primary end point was the 30-day rate of stroke. We also determined the rate of stroke at the midterm follow-up and investigated whether there was an interaction between revascularization type and the extent of coronary artery disease on the relative risk of stroke.
Results:
The 30-day rate of stroke was 1.20% after CABG compared with 0.34% after PCI (odds ratio: 2.94, 95% confidence interval: 1.69 to 5.09, p < 0.0001). Similar results were observed after a median follow-up of 12.1 months (1.83% vs. 0.99%, odds ratio: 1.67, 95% confidence interval: 1.09 to 2.56, p = 0.02). The extent of coronary artery disease (single vessel vs. multivessel vs. left main) did not affect the relative increase in the risk of stroke observed with CABG compared with PCI at either 30 days (p = 0.57 for interaction) or midterm follow-up (p = 0.08 for interaction). Similar results were observed when the outcomes in 33,980 patients from 27 observational studies were analyzed.
Conclusions:
Coronary revascularization by CABG compared with PCI is associated with an increased risk of stroke at 30 days and at the mid-term follow-up.
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