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Updated: May 1, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary artery bypass graft surgery versus percutaneous coronary intervention with first-generation drug-eluting
Juwairia Al Ali1, Caroline Franck2, Kristian B Filion3
1Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada.
Insights
Coronary artery bypass graft surgery (CABG) is more effective than percutaneous coronary intervention (PCI) for multivessel and left main disease, but increases stroke risk. Efficacy for single-vessel LAD disease remains unclear.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Trials
Background:
- The comparative efficacy and safety of CABG versus PCI with drug-eluting stents in specific patient subgroups is a subject of ongoing debate.
- Evidence is particularly needed for patients with multivessel disease (MVD), unprotected left main (LM) disease, and single-vessel proximal LAD disease.
Purpose of the Study:
- To compare the efficacy of CABG with first-generation drug-eluting stent PCI.
- To evaluate outcomes in patients with MVD, unprotected LM disease, and single-vessel proximal LAD disease.
Main Methods:
- Systematic literature search of randomized controlled trials (RCTs) published up to June 2013.
- Included trials comparing CABG and PCI, with primary endpoints of mortality, myocardial infarction, revascularization, and stroke.
- Meta-analysis using random-effects models.
Main Results:
- Seven RCTs (N=5,835) were included, encompassing MVD, LM disease, and single-vessel proximal LAD disease cohorts.
- In MVD patients, CABG reduced mortality, myocardial infarction, and repeat revascularization but increased stroke risk.
- In LM disease patients, CABG reduced revascularization but increased stroke risk; data for single-vessel proximal LAD disease were inconclusive.
Conclusions:
- CABG demonstrates superior efficacy compared to PCI with first-generation drug-eluting stents in patients with LM and MVD.
- This improved efficacy comes with an increased risk of stroke.
- No definitive conclusions could be drawn regarding the efficacy of CABG versus PCI for single-vessel proximal LAD disease.
Objectives:
This study sought to compare the efficacy of coronary artery bypass graft surgery (CABG) to that of percutaneous coronary intervention (PCI) with first-generation drug-eluting stents among patients with multivessel disease (MVD), unprotected left main (LM) disease, and single-vessel proximal left anterior descending (LAD) disease.
Background:
The efficacy and safety of CABG versus PCI with drug-eluting stents in patient subgroups remains controversial.
Methods:
We systematically searched Cardiosource, Circulation, Clinicaltrials.gov, the Cochrane Library, EMBASE, and Medline for articles published through June 2013 for randomized controlled trials comparing CABG with PCI. Primary endpoints included mortality, myocardial infarction, revascularization, and stroke. Data were meta-analyzed with random-effects models.
Results:
We identified 7 randomized controlled trials (N = 5,835): 2 of MVD (n = 2,410, 100% diabetic), 2 of LM disease (n = 1,206, 29.0% diabetic), 1 of 3-vessel or LM disease (n = 1,900, 25.5% diabetic), and 2 of single-vessel proximal LAD disease (n = 319, 36.3% diabetic). In MVD patients, CABG reduced the risk of mortality (risk ratio [RR]: 0.70, 95% confidence interval [CI]: 0.57 to 0.87), myocardial infarction (RR: 0.47, 95% CI: 0.36 to 0.61), and repeat revascularization (RR: 0.36, 95% CI: 0.24 to 0.52), but increased stroke risk (RR: 1.72, 95% CI: 1.02 to 2.90). In patients with LM disease, CABG reduced revascularization risk (RR: 0.60, 95% CI: 0.46 to 0.78) and increased stroke risk (RR: 2.89, 95% CI: 1.15 to 7.27). Data for patients with single-vessel proximal LAD disease were inconclusive.
Conclusions:
CABG is more efficacious than is PCI with first-generation drug-eluting stents in patients with LM and MVD, at the cost of increased rates of stroke. No conclusion can be drawn for patients with single-vessel proximal LAD disease.
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