Bypass grafting versus percutaneous intervention in multivessel coronary disease: the current state

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Clinical Trials Methodology

Background:

• Debate persists regarding optimal revascularization for multivessel disease: stenting versus coronary artery bypass grafting (CABG).
• Previous trials comparing stenting and CABG were often underpowered for mortality outcomes.
• Conflicting results from individual studies led to a common preference for stenting due to its less invasive nature.

Purpose of the Study:

• To definitively compare the long-term efficacy of CABG versus stenting in patients with multivessel coronary artery disease.
• To resolve the controversy surrounding the best revascularization strategy by leveraging meta-analysis.
• To assess mortality and myocardial infarction rates between the two treatment modalities.

Main Methods:

• A comprehensive meta-analysis was conducted on available high-quality randomized trials.
• Individual patient data or aggregated trial data were pooled to increase statistical power.
• Outcomes were analyzed comparing CABG to stenting in patients with multivessel disease.

Main Results:

• Coronary artery bypass grafting (CABG) demonstrated unequivocal reductions in mortality compared to stenting.
• CABG also led to significant reductions in myocardial infarctions in patients with multivessel disease.
• These benefits were consistent across subgroups, including diabetic patients and those treated with either bare-metal or drug-eluting stents.

Conclusions:

• Coronary artery bypass grafting (CABG) is the superior revascularization strategy for patients with multivessel disease, offering significant survival and cardiac event benefits over stenting.
• The findings provide strong evidence to guide clinical decision-making in complex coronary artery disease.
• Meta-analysis effectively resolved the limitations of underpowered individual trials, establishing a clear preference for CABG.