Key result
Alternative CABG approaches demonstrated favorable rates of long-term mortality, MACCE, MI, and repeat revascularization compared with PCI, with similar short-term mortality and stroke.
Why the study?
Alternative CABG approaches are increasingly used to address the increased early risk of conventional CABG, but contemporary literature comparing outcomes after ACABG versus PCI needed review.
Do alternative CABG (ACABG) approaches improve clinical outcomes compared to PCI in patients with severe symptomatic CAD?
Meta-Analysis
Do alternative CABG (ACABG) approaches improve clinical outcomes compared to PCI in patients with severe symptomatic CAD?
Alternative CABG approaches may offer favorable long-term outcomes regarding MACCE, MI, and repeat revascularization compared to PCI, while maintaining similar short-term safety.
Supports ACABG preference over PCI in severe CAD to lower MACCE; extends meta-analytic evidence for alternative surgical strategies.
Coronary artery disease (CAD) is a leading cause of mortality worldwide. Severe symptomatic CAD is treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Alternative CABG (ACABG) approaches including thoracotomy, off-pump, total endoscopic, and robotic-assisted CABG are increasing in prevalence to address the increased early risk of CABG. This systematic review and meta-analysis aims to review the contemporary literature comparing outcomes after ACABG and PCI. Pubmed, Medline, and Embase were systematically searched by 2 authors for articles comparing the outcomes after ACABG and PCI. A total of 1154 articles were screened, and 11 were included in this review. The RevMan 5.4 software was used to perform a meta-analysis of the pooled data. Individual studies found rates of long-term survival, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction (MI), and repeat revascularization either favored ACABG or did not differ significantly. Pooled estimates of the compiled data identified rates of MACCE, MI, and repeat revascularization favored ACABG. The results of this review demonstrated the favorable rates of long-term mortality, MACCE, MI, and repeat revascularization for ACABG in addition to similar short-term mortality and stroke when compared with PCI. Advancement of both CABG and PCI continues to improve patient outcomes. With the increasing prevalence of ACABG, similar studies will need to be undertaken with further direct comparisons between ACABG and PCI. Finally, hybrid revascularization should continue to be explored for its combined benefits of long-term outcomes, short-term safety, and ability to achieve complete revascularization.
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EL‐Andari et al. (2023) conducted a meta-analysis in Severe symptomatic coronary artery disease. Alternative coronary artery bypass grafting (ACABG) vs. Percutaneous coronary intervention (PCI) was evaluated on Long-term mortality, MACCE, MI, and repeat revascularization. Alternative CABG approaches demonstrated favorable rates of long-term mortality, MACCE, MI, and repeat revascularization compared with PCI, with similar short-term mortality and stroke.
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