Long‐Term Clinical Outcomes of CABG vs. PCI With DES for Multivessel and Left‐Main Coronary Artery Disease: A Systematic Review and Meta‐Analysis

Background Current guidelines favor Coronary Artery Bypass Graft (CABG) Surgery over Percutaneous Coronary Intervention (PCI) for multivessel (MVD) and left main coronary artery disease (LM‐CAD) due to better outcomes. However, the FAME‐3 trial suggests similar long‐term results between PCI and CABG for triple‐vessel disease. To explore this discrepancy, we conducted a systematic review and meta‐analysis of randomized controlled trials comparing CABG and PCI with DES, assessing differences in all‐cause mortality, target vessel revascularization (TVR), and major adverse cardiovascular and cerebrovascular events (MACCE) over at least 3 years. Methods RCTs comparing CABG with PCI, reporting outcomes on at least 3 years (36 months) of follow‐up, were included. Using an Intention‐to‐treat analysis, the primary outcome was assessed as the relative risk of all‐cause mortality, while secondary outcomes consisted of TVR and MACCE. We also performed subgroup analysis based on the type of coronary artery disease (LM‐CAD or MVD) and SYNTAX scores. Results CABG did not show any significant benefit in terms of all‐cause mortality when compared to PCI for either LM‐CAD or MVD (RR: 0.90, 95% CI: 0.78, 1.04). It had a lower risk of all‐cause mortality in patients with SYNTAX < 23 and a lower risk of MACCE (RR: 0.75, 95% CI: 0.70, 0.81) and TVR (RR: 0.50, 95% CI: 0.38, 0.66) across all subgroups regardless of the SYNTAX score. Conclusions While no major mortality difference was noted between CABG and PCI, the risk of MACCE and TVR was lower with CABG in both LM‐CAD and MVCAD across all SYNTAX scores. This should be discussed at length with patients, as it may impact decision‐making.