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April 1, 2023The American Journal of CardiologyOpen Access

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Non–ST-Elevation Coronary Syndromes and Multivessel Disease: A Systematic Review and Meta-Analysis

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Why the study?

There is a lack of evidence regarding the optimal revascularization strategy in patients with non-ST-elevation acute coronary syndrome and multivessel disease.

Does percutaneous coronary intervention reduce all-cause mortality at 1 year compared to coronary artery bypass graft surgery in patients with non-ST-elevation acute coronary syndrome and multivessel disease?

Comparison

PCI vs CABG

Design

Systematic review and meta-analysis

Follow-up

1 year

Key result

Percutaneous coronary intervention and coronary artery bypass grafting resulted in similar 1-year all-cause mortality in patients with NSTE-ACS and multivessel disease (OR 0.91; 95% CI 0.68-1.21; P=0.51).

Authors

HKHala KakarFGFrederik T.W. GroenlandJEJacob J Elscot

Discussion

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Overview

PCI and CABG yield similar 1-year mortality; confirms comparable safety and supports individualized choice in NSTE-ACS multivessel disease.

Study Design

Type

Systematic Review and Meta-Analysis (n=3,172)

Structured PICO

Does percutaneous coronary intervention reduce all-cause mortality at 1 year compared to coronary artery bypass graft surgery in patients with non-ST-elevation acute coronary syndrome and multivessel disease?

P
Population
3,172 patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD) pooled from 4 prospective observational studies (1,542 underwent CABG, 1,630 underwent PCI)
I
Intervention
Percutaneous coronary intervention (PCI)
C
Comparator
Coronary artery bypass graft surgery (CABG)
O
Outcome
All-cause mortality at 1 yearhard clinical

Main Result

Effect estimate: OR 0.91 (95% CI 0.68 to 1.21)

p-value: p=0.51

In patients with NSTE-ACS and multivessel disease, PCI and CABG have similar 1-year rates of mortality, MI, and stroke, though PCI is associated with a higher rate of repeat revascularization.

Limitations

  • Lack of randomized controlled trials

Cite This Study

Kakar et al. (2023) conducted a systematic review and meta-analysis in Non-ST-elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD) (n=3,172). Percutaneous coronary intervention (PCI) vs. Coronary artery bypass graft surgery (CABG) was evaluated on All-cause mortality at 1 year (OR 0.91, 95% CI 0.68 to 1.21, p=0.51). Percutaneous coronary intervention and coronary artery bypass grafting resulted in similar 1-year all-cause mortality in patients with NSTE-ACS and multivessel disease (OR 0.91; 95% CI 0.68-1.21; P=0.51).

synapsesocial.com/papers/6a11bed64bf0131c39178c22https://doi.org/10.1016/j.amjcard.2023.03.005
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