What is the clinical evidence from this study?

Study design: Systematic Review. Population: Coronary artery disease (n=186696). Intervention: Coronary artery bypass grafting vs. Percutaneous coronary intervention. Primary outcome: Long-term all-cause mortality (mortality difference -5.59%).

December 22, 2022Scientific Reports39 citationsOpen Access

Comparing CABG and PCI across the globe based on current regional registry evidence

TCTúlio CaldonazoCardiac Surgery HKHristo KirovCardiac Surgery LRLeoni Lu RiedelFriedrich Schiller University Jena

Key Result

Coronary artery bypass grafting was associated with better long-term survival compared to percutaneous coronary intervention in most regions of the world, with an average mortality difference of -5.59%.

Study Design

Type

Systematic Review (n=186,696)

Multicenter

Yes

Structured PICO

Does CABG improve long-term survival compared to PCI in patients with coronary artery disease?

Population

186,696 patients with coronary artery disease from 23 regional studies across 18 countries, comparing long-term survival after CABG versus PCI with a mean follow-up of 4.7 years.

Intervention

Coronary artery bypass grafting (CABG)

Comparator

Percutaneous coronary intervention (PCI)

Outcome

Long-term survival (all-cause mortality)hard clinical

Based on regional registry evidence, CABG is associated with better long-term survival compared to PCI in most regions of the world without evidence for higher periprocedural mortality.

Main Result

Effect estimate: mortality difference -5.59%

Absolute Risk Reduction: 5.59%

Limitations

Registry data are burdened with various biases including selection, treatment allocation, and publication biases
Possible selection bias in propensity matched registry populations
Differences in exclusion criteria across included studies

Abstract

There is an ongoing debate whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) provide better results for the treatment of coronary artery disease (CAD). We aimed to evaluate the impact of CABG or PCI on long-term survival based on local reports from different regions in the world. We systematically searched MEDLINE selecting studies that compared outcomes for CABG or PCI as a treatment for CAD in the last 10 years. Reports without all-cause mortality, multi-national cohorts, hybrid revascularization populations were excluded. Qualifying studies were statistically compared, and their geographic location visualized on a world map. From 5126 studies, one randomized and twenty-two observational studies (19 risk-adjusted) met the inclusion criteria. The mean follow-up was 4.7 ± 7 years and 18 different countries were included. In 17 studies, CABG was associated with better survival during follow-up, six studies showed no significant difference, and no study favored PCI. Periprocedural mortality was not different in seven, lower with PCI in one, lower with CABG in three and not reported in 12 studies. In regional registry-type comparisons, CABG is associated with better long-term survival compared to PCI in most regions of the world without evidence for higher periprocedural mortality.

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