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Updated: Dec 9, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients with Left Ventricular Systolic
Mahin R Khan1, Waleed T Kayani2, Jason Pelton2
1Division of Cardiology, McLaren-Flint/Michigan State University, Flint, MI, USA.
Insights
Coronary artery bypass grafting (CABG) shows better long-term survival than percutaneous coronary intervention (PCI) for patients with left ventricular dysfunction (LVD). CABG also reduces repeat procedures, though PCI has lower initial stroke rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Left ventricular systolic dysfunction (LVD) affects millions, necessitating optimal revascularization strategies.
- Comparative data on percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in LVD patients is limited.
Purpose of the Study:
- To compare clinical outcomes of PCI and CABG in patients with LVD (LVEF ≤ 40%).
- To evaluate mortality, myocardial infarction, stroke, and repeat revascularization rates.
Main Methods:
- Aggregate data meta-analysis of 17 studies (16 observational, 1 randomized) including 18,599 patients.
- Random effects model used to compare PCI and CABG outcomes at 30 days, 3 years, and long-term (mean 6.3 years).
Main Results:
- All-cause mortality was comparable at 30 days and 3 years.
- PCI was associated with increased long-term mortality (31.6% vs. 24.3%) and higher repeat revascularization rates.
- Long-term stroke and myocardial infarction rates were similar; PCI had lower 30-day and 3-year stroke rates.
Conclusions:
- CABG demonstrates lower long-term mortality and revascularization rates in LVD patients.
- PCI offers lower upfront stroke risk but higher long-term mortality.
- Need for more randomized trials due to predominantly observational data.
Purpose:
There is a paucity of comparative data examining the optimal revascularization strategy in patients with left ventricular systolic dysfunction (LVD).
Methods:
We performed an aggregate data meta-analysis of clinical outcomes comparing percutaneous coronary intervention (PCI) versus coronary artery bypass (CABG) in patients with LVD (left ventricle ejection fraction (LVEF) of ≤ 40%), using the random effects model. Effects size is reported as odds ratio (OR) and a 95% confidence interval. Outcomes included all-cause mortality, myocardial infarction, stroke, repeat revascularization, and a composite of major adverse cardiac and cerebrovascular events (MACCE) at 30-day, 3-year, and long-term (6.3 ± 0.9 years) follow-ups. Seventeen studies (16 observational, 1 randomized) and 18,599 patients (CABG 9651; PCI 8948) were included.
Results:
PCI and CABG had comparable all-cause mortality at 30 days (OR 0.78, 95% CI 0.49-1.23) and 3 years (OR 1.05, 95% CI 0.91-1.21); however, PCI was associated with increased long-term morality after a mean follow-up of 6.3 ± 0.9 years (31.6% vs. 24.3%, OR 1.41, 95% CI 1.21-1.64). A similar mortality trend was observed in the subgroup of patients with EF ≤ 35%. PCI had a higher rate of repeat revascularization at 3-year and long-term follow-ups. The long-term rates of stroke and MI were comparable. PCI, on the other hand, had lower rates of stroke at 30-day and 3-year follow-ups.
Conclusion:
CABG was associated with lower rates of long-term mortality and revascularization but higher rate of upfront stroke in patients with LVD. However, the data included consisted predominantly of observational studies, highlighting the paucity and need for randomized trials.
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