Stent versus Coronary Artery Bypass Surgery in Multi-Vessel and Left Main Coronary Artery Disease: A Meta-Analysis of
Pedro José Negreiros de Andrade1,2, João Luiz de Alencar Araripe Falcão1,2, Breno de Alencar Araripe Falcão1,2
1Hospital Dr. Carlos Alberto Studart Gomes de Messejana, Fortaleza, CE - Brazil.
Insights
Percutaneous coronary intervention (PCI) using stents offers lower short-term mortality and stroke rates compared to Coronary Artery Bypass Grafting (CABG). However, CABG shows better long-term survival, especially for diabetic patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Evidence-Based Medicine
Background:
- The optimal revascularization strategy for multi-vessel and unprotected left main coronary artery disease (LMCAD) between percutaneous coronary intervention (PCI) using stents and Coronary Artery Bypass Grafting (CABG) remains a subject of debate.
- This study addresses the controversial comparison of PCI versus CABG in treating complex coronary artery disease.
Purpose of the Study:
- To perform a systematic review and meta-analysis comparing PCI with stents versus CABG.
- To evaluate short-term and long-term outcomes, including mortality and stroke incidence, in patients undergoing PCI or CABG for multi-vessel and unprotected LMCAD.
Main Methods:
- A systematic search of electronic databases identified 15 randomized controlled trials (RCTs) comparing PCI with stents versus CABG.
- Data from 12,781 patients were pooled for meta-analysis, with statistical significance set at p < 0.05.
- Subgroup analyses were conducted for diabetic patients and those with LMCAD.
Main Results:
- Pooled data revealed lower 30-day mortality (1% vs 1.7%) and stroke rates (0.6% vs 1.7%) with PCI compared to CABG.
- No significant differences in one- and two-year mortality were observed between the two interventions.
- Long-term mortality favored CABG (10.6% vs 9.4%), particularly in the Drug-Eluting Stent (DES) era and in diabetic patients (13.7% vs 10.3%).
- For LMCAD, PCI showed a lower stroke incidence (0.3% vs 1.5%) without significant differences in mortality outcomes.
- Diabetes and high SYNTAX scores were identified as factors adversely impacting PCI outcomes.
Conclusions:
- PCI with stents demonstrates reduced 30-day mortality and stroke incidence relative to CABG.
- CABG is associated with improved long-term survival, especially in diabetic patients and those with complex disease.
- The choice between PCI and CABG should consider patient-specific factors like diabetes and coronary anatomy (SYNTAX score).
Background:
Comparison between percutaneous coronary intervention (PCI) using stents and Coronary Artery Bypass Grafting (CABG) remains controversial.
Objective:
To conduct a systematic review with meta-analysis of PCI using Stents versus CABG in randomized controlled trials.
Methods:
Electronic databases were searched to identify randomized trials comparing PCI using Stents versus CABG for multi-vessel and unprotected left main coronary artery disease (LMCAD). 15 trials were found and their results were pooled. Differences between trials were considered significant if p < 0.05.
Results:
In the pooled data (n = 12,781), 30 days mortality and stroke were lower with PCI (1% versus 1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus 6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p = 0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In diabetics (n = 3,274) long term mortality favored CABG (13.7% versus 10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus 8.1%) between PCI and CABG; the incidence of stroke was lower with PCI (0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the subgroups that influenced more adversely the results of PCI.
Conclusion:
Compared with CABG, PCI using Stents showed lower 30 days mortality, higher late mortality and lower incidence of stroke. Diabetes and a high SYNTAX were the subgroups that influenced more adversely the results of PCI.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation