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Percutaneous coronary invervention versus coronary artery bypass grafting: a meta-analysis

Yolba Smit1, Joan Vlayen2, Hetty Koppenaal3

  • 1Independent Researcher, Leuth, The Netherlands.

The Journal of Thoracic and Cardiovascular Surgery
|December 4, 2014
PubMed

Insights

Coronary artery bypass grafting (CABG) shows lower death rates than percutaneous coronary intervention (PCI) for multivessel disease or diabetes patients. However, CABG increases stroke risk, while PCI requires more repeat revascularizations.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) is a leading cause of mortality worldwide.
  • Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are primary revascularization strategies for CAD.
  • Choosing between PCI and CABG involves complex risk-benefit assessments for patient outcomes.

Purpose of the Study:

  • To conduct a meta-analysis comparing the long-term effectiveness of PCI versus CABG in patients with coronary artery disease.
  • To evaluate differences in mortality, myocardial infarction, repeat revascularization, and stroke between PCI and CABG.
  • To stratify outcomes based on disease severity (e.g., multivessel disease) and patient comorbidities (e.g., diabetes).

Main Methods:

  • Systematic literature search of MEDLINE, Embase, and Cochrane Central databases.
  • Inclusion of randomized controlled trials (RCTs) comparing PCI and CABG.
  • Assessment of outcomes at maximum available follow-up duration across included trials.

Main Results:

  • The meta-analysis included 31 trials with 15,004 patients.
  • Higher mortality was observed following PCI compared to CABG, particularly in patients with multivessel disease or diabetes (OR, 1.1-1.6).
  • Repeat revascularization was significantly more common after PCI (OR, 4.5), with decreasing rates correlating with stent advancements (drug-eluting stents showing lower rates).
  • Myocardial infarction rates were similar between PCI and CABG (OR, 1.2), while stroke risk was higher after CABG (OR, 0.7).

Conclusions:

  • Coronary artery bypass grafting (CABG) offers a survival benefit over percutaneous coronary intervention (PCI) for patients with multivessel disease or diabetes.
  • PCI is associated with a higher need for repeat revascularization, although this has decreased with newer stent technologies.
  • CABG is linked to an increased risk of stroke, necessitating careful consideration of patient-specific factors when selecting revascularization strategy.
Abstract

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