How "Fragile" Is the Debate Against Coronary Artery Bypass Grafting?

Area of Science:

• Cardiology
• Clinical Trials
• Evidence-Based Medicine

Background:

• The debate between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for coronary revascularization is ongoing.
• Randomized controlled trials (RCTs) compare these revascularization methods.
• The fragility index (FI) quantifies the robustness of RCT results.

Purpose of the Study:

• To assess the robustness of existing RCTs comparing PCI and CABG.
• To evaluate the strength of evidence for each revascularization strategy.

Main Methods:

• A PubMed search identified RCTs comparing PCI and CABG published within the last 20 years.
• RCTs with significant dichotomous outcomes were selected.
• The fragility index was calculated for significant primary outcomes and averaged.

Main Results:

• Nine RCTs met the inclusion criteria.
• The average FI for major adverse cardiovascular or cerebrovascular events favoring CABG was 18.
• No RCTs significantly favored PCI over CABG for major adverse cardiac events.

Conclusions:

• RCTs supporting CABG demonstrate greater robustness compared to those supporting PCI.
• While some RCTs show no significant difference between PCI and CABG, their results are less robust.
• The optimal revascularization strategy is multifactorial and depends on individual patient characteristics.