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Updated: Jun 15, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Percutaneous coronary intervention with drug-eluting stents versus coronary bypass surgery for coronary artery
Michal J Kawczynski1, Andrea Gabrio2, Jos G Maessen1
1Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Insights
Coronary artery bypass grafting (CABG) shows a survival benefit over drug-eluting stent percutaneous coronary intervention (DES-PCI) for coronary artery disease at 5 years. CABG reduces mortality, myocardial infarction, and repeat revascularization compared to DES-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) management often involves revascularization.
- Percutaneous coronary intervention with drug-eluting stents (DES-PCI) and coronary artery bypass grafting (CABG) are primary treatment options.
- Evidence comparing long-term outcomes is crucial for clinical decision-making.
Purpose of the Study:
- To systematically evaluate randomized controlled trials comparing DES-PCI and CABG for CAD.
- To assess the long-term efficacy and safety of both revascularization strategies at 5-year follow-up.
- To provide data for guiding treatment choices in patients with CAD.
Main Methods:
- A systematic literature search was conducted across three electronic databases.
- Randomized trials with 5-year follow-up comparing DES-PCI and CABG were included.
- A Bayesian hierarchical meta-analytic model analyzed all-cause mortality, stroke, myocardial infarction, and repeat revascularization.
Main Results:
- Six trials involving 8269 patients were analyzed.
- DES-PCI was associated with increased 5-year all-cause mortality (RR 1.23, absolute risk difference +2.3%).
- CABG demonstrated benefits in reduced myocardial infarction and repeat revascularization, while DES-PCI showed a trend towards fewer strokes.
Conclusions:
- CABG offers a significant survival advantage over DES-PCI at 5 years for CAD patients.
- CABG is associated with lower rates of myocardial infarction and repeat revascularization.
- Findings support CABG in shared decision-making, balancing mortality benefits against a higher stroke risk.
Objectives:
Coronary revascularization is frequently performed for coronary artery disease (CAD). This study aims to assess the totality of randomized evidence comparing percutaneous coronary intervention with drug-eluting stents (DES-PCI) with coronary artery bypass grafting (CABG) for CAD.
Methods:
A systematic search was applied to 3 electronic databases, including randomized trials comparing DES-PCI with CABG for CAD with 5-year follow-up. A Bayesian hierarchical meta-analytic model was applied. The primary outcome was all-cause mortality at 5 years; secondary outcomes were stroke, myocardial infarction, and repeat revascularization. End points were reported in median relative risks (RRs) and absolute risk differences, with 95% credible intervals (CrIs). Kaplan-Meier curves were used to reconstruct individual patient data.
Results:
Six studies comprising 8269 patients (DES-PCI, n = 4134; CABG, n = 4135) were included. All-cause mortality at 5 years was increased with DES-PCI (median RR, 1.23; 95% CrI, 1.01-1.45), with a median absolute risk difference of +2.3% (95% CrI, 0.1%-4.5%). For stroke, myocardial infarction, and repeat revascularization, the median RRs were 0.79 (95% CrI, 0.54-1.25), 1.84 (95% CrI, 1.23-2.75), and 1.80 (95% CrI, 1.51-2.16) for DES-PCI, respectively. In a sample of 1000 patients undergoing DES-PCI instead of CABG for CAD, a median of 23 additional deaths, 46 myocardial infarctions, and 85 repeat revascularizations occurred at 5 years, whereas 10 strokes were prevented.
Conclusions:
The current data suggest a clinically relevant benefit of CABG over DES-PCI at 5 years in terms of mortality, myocardial infarction, and repeat revascularization, despite an increased risk of stroke. These findings may guide the heart-team and the shared decision-making process.
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