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Updated: Sep 27, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease: A
Nicholas W S Chew1, Jin Hean Koh2, Cheng Han Ng2
1Department of Cardiology, National University Heart Centre, Singapore, Singapore.
Insights
Coronary artery bypass grafting (CABG) shows lower 10-year mortality than percutaneous coronary intervention (PCI) for multivessel disease without left main involvement. This benefit is pronounced in patients with moderate to high SYNTAX scores.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Emerging data compare 10-year mortality for coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with stenting in multivessel disease (MVD) without left main (LM) involvement.
- Previous studies suggest varying outcomes, necessitating updated analyses with individual patient data.
Approach:
- An updated two-stage meta-analysis was performed using reconstructed individual patient data.
- Six randomized controlled trials (7,181 patients) comparing CABG and PCI for MVD were included.
- All-cause mortality was analyzed using shared-frailty and stratified Cox models, with subgroup analysis by SYNTAX score.
Key Points:
- PCI was associated with a significantly higher 10-year all-cause mortality risk compared to CABG (HR: 1.282).
- In patients with low SYNTAX scores, 10-year mortality was comparable between PCI and CABG (HR: 1.102).
- For moderate to high SYNTAX scores, PCI showed significantly higher 10-year mortality than CABG (HRs: 1.444 and 1.856, respectively).
Conclusions:
- Coronary artery bypass grafting (CABG) demonstrates sustained lower cumulative all-cause mortality compared to percutaneous coronary intervention (PCI) for multivessel disease without left main involvement.
- The findings support CABG as a potentially superior revascularization strategy in specific MVD patient populations based on long-term survival data.
Background And Aims:
Data are emerging on 10-year mortality comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stenting for multivessel disease (MVD) without left main (LM) involvement. We conducted an updated two-stage meta-analysis using reconstructed individual patient data to compare long-term mortality between CABG and PCI for patients with MVD without significant LM coronary disease.
Methods:
Medline and Embase databases were searched for articles comparing CABG with PCI for MVD. A two-stage meta-analysis was conducted using reconstructed patient level survival data for all-cause mortality with subgroups by SYNTAX score. The shared-frailty and stratified Cox models were fitted to compare survival endpoints.
Results:
We screened 1,496 studies and included six randomized controlled trials with 7,181 patients. PCI was associated with greater 10-year all-cause mortality risk (HR: 1.282, CI: 1.118-1.469, p < 0.001) compared with CABG. In patients with low SYNTAX score, 10-year all-cause mortality after PCI was comparable to CABG (HR: 1.102, 0.822-1.479, p = 0.516). However, in patients with moderate to high SYNTAX score, 10-year all-cause mortality was significantly higher after PCI compared with CABG (HR: 1.444, 1.122-1.858, p < 0.001; HR: 1.856, 1.380-2.497, p < 0.001, respectively).
Conclusion:
This updated reconstructed individual patient-data meta-analysis revealed a sustained lower cumulative all-cause mortality of CABG over PCI for multivessel disease without LM involvement.
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