Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are primary revascularization strategies for multivessel and left main coronary artery disease.
• Stroke is a significant, feared complication following coronary revascularization procedures.
• Detecting differences in stroke rates between CABG and PCI requires large-scale patient studies due to the infrequency of this complication.

Purpose of the Study:

• To compare the rates of stroke following CABG versus PCI.
• To evaluate the impact of procedural stroke on long-term patient mortality.

Main Methods:

• A collaborative pooled analysis of individual patient data from 11 randomized clinical trials comparing CABG and PCI.
• Included 11,518 patients (5,753 PCI, 5,765 CABG) with a mean follow-up of 3.8 years.
• Stroke rates at 30 days and 5 years were compared using a random effects Cox proportional hazards model; impact of stroke on 5-year mortality was assessed.

Main Results:

• At 30 days, stroke rates were significantly lower after PCI (0.4%) compared to CABG (1.1%) (HR: 0.33).
• At 5 years, stroke remained significantly lower after PCI (2.6%) than CABG (3.2%) (HR: 0.77), driven by the early post-procedural period.
• Stroke rates between 31 days and 5 years were comparable (2.2% PCI vs. 2.1% CABG).
• Patients experiencing stroke within 30 days had markedly higher 5-year mortality regardless of procedure (45.7% PCI vs. 41.5% CABG).

Conclusions:

• PCI is associated with significantly lower 5-year stroke rates compared to CABG, primarily due to a reduced risk in the early post-procedural phase.
• The benefit of PCI over CABG regarding stroke risk was most pronounced in diabetic patients.
• Procedural stroke within 30 days significantly increases long-term mortality risk following either CABG or PCI.