Long-Term Safety and Efficacy of Percutaneous Coronary Intervention With Stenting and Coronary Artery Bypass Surgery for Multivessel Coronary Artery Disease
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Discussion
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Implication
Pooled analysis of randomized trials finds comparable safety but fewer repeat procedures with coronary bypass versus stenting in multivessel disease, highlighting distinct long-term outcomes.
Key Points
- To evaluate the long-term 5-year safety and efficacy of percutaneous coronary intervention with stenting compared to coronary artery bypass grafting in patients with multivessel coronary artery disease.
- Pooled analysis of individual data from 4 randomized controlled trials (total N=3,051).
- Evaluated patients undergoing percutaneous coronary intervention (PCI) with bare metal stenting versus coronary artery bypass grafting (CABG) with a 5-year follow-up.
- Primary endpoint was a composite of death, stroke, or myocardial infarction; secondary endpoint evaluated major adverse cardiac and cerebrovascular events (MACCE), including repeat revascularization.
- The 5-year cumulative incidence of the primary composite safety endpoint (death, MI, stroke) was 16.7% for PCI versus 16.9% for CABG (HR 1.04, 95% CI 0.86 to 1.27; P=0.69).
- Repeat revascularization occurred significantly more often with PCI than CABG (29.0% vs. 7.9%; HR 0.23, 95% CI 0.18 to 0.29; P<0.001).
- Overall MACCE rates were significantly higher in the PCI group compared to the CABG group (39.2% vs. 23.0%; HR 0.53, 95% CI 0.45 to 0.61; P<0.001), with consistent results across diabetic and 3-vessel disease subgroups.
Cite This Study
Daemen et al. (2008) studied this question.