Key result
PCI using stents compared with CABG showed lower 30-day mortality (1% vs 1.7%, p=0.01) and stroke, but higher long-term mortality (10.6% vs 9.4%, p=0.04).
Why the study?
Comparison between percutaneous coronary intervention using stents and coronary artery bypass grafting remains controversial.
Does percutaneous coronary intervention using stents reduce mortality and stroke compared to coronary artery bypass grafting in patients with multi-vessel and left main coronary artery disease?
Meta-Analysis (n=12,781)
Does percutaneous coronary intervention using stents reduce mortality and stroke compared to coronary artery bypass grafting in patients with multi-vessel and left main coronary artery disease?
Absolute Event Rate: 1% vs 1.7%
p-value: p=0.01
PCI with stents offers lower short-term mortality and stroke risk compared to CABG, but CABG provides a long-term survival advantage, particularly in patients with diabetes or high SYNTAX scores.
PCI lowers early mortality and stroke versus CABG but raises long-term mortality; reinforces individualized revascularization based on risk and anatomy.
BACKGROUND: Comparison between percutaneous coronary intervention (PCI) using stents and Coronary Artery Bypass Grafting (CABG) remains controversial. OBJECTIVE: To conduct a systematic review with meta-analysis of PCI using Stents versus CABG in randomized controlled trials. METHODS: Electronic databases were searched to identify randomized trials comparing PCI using Stents versus CABG for multi-vessel and unprotected left main coronary artery disease (LMCAD). 15 trials were found and their results were pooled. Differences between trials were considered significant if p < 0.05. RESULTS: In the pooled data (n = 12,781), 30 days mortality and stroke were lower with PCI (1% versus 1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus 6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p = 0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In diabetics (n = 3,274) long term mortality favored CABG (13.7% versus 10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus 8.1%) between PCI and CABG; the incidence of stroke was lower with PCI (0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the subgroups that influenced more adversely the results of PCI. CONCLUSION: Compared with CABG, PCI using Stents showed lower 30 days mortality, higher late mortality and lower incidence of stroke. Diabetes and a high SYNTAX were the subgroups that influenced more adversely the results of PCI.
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Andrade et al. (2019) conducted a meta-analysis in Multi-vessel and unprotected left main coronary artery disease (LMCAD) (n=12,781). PCI using Stents vs. Coronary Artery Bypass Grafting (CABG) was evaluated on 30 days mortality (p=0.01). PCI using stents compared with CABG showed lower 30-day mortality (1% vs 1.7%, p=0.01) and stroke, but higher long-term mortality (10.6% vs 9.4%, p=0.04).
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