Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Clinical Trials Methodology

Background:

• Mortality rates are a critical endpoint in trials comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
• Debate exists on whether all-cause or cardiac mortality is the preferred endpoint, as non-cardiac mortality is presumed unrelated to treatment.

Purpose of the Study:

• To compare all-cause and cause-specific mortality between PCI and CABG in patients with coronary artery disease using randomized clinical trials (RCTs).

Main Methods:

• Systematic search of MEDLINE, Embase, and Cochrane Library databases up to November 2019.
• Inclusion of RCTs comparing PCI (with drug-eluting or bare-metal stents) to CABG, focusing on trials reporting mortality outcomes.
• Data extraction and synthesis followed PRISMA guidelines, with pooled analysis using fixed- and random-effects models.

Main Results:

• Twenty-three RCTs with 13,620 patients were analyzed, with a mean follow-up of 5.3 years.
• PCI was associated with significantly higher all-cause mortality (IRR, 1.17) and cardiac mortality (IRR, 1.24) compared to CABG.
• Notably, PCI also showed higher non-cardiac mortality (IRR, 1.19) compared to CABG.

Conclusions:

• PCI demonstrated higher rates of all-cause, cardiac, and non-cardiac mortality compared to CABG at 5-year follow-up.
• The increased non-cardiac mortality with PCI suggests potential procedure-related causes, reinforcing the utility of all-cause mortality as a primary endpoint in myocardial revascularization studies.