Key result
PCI linked to ~78% higher mortality than multiple arterial CABG in multivessel CAD.
Why the study?
Multiple arterial CABG has superior long-term outcomes compared with single arterial CABG, but randomized trials versus PCI largely evaluated single arterial grafting strategies, leaving evidence comparing multiple arterial CABG with PCI limited.
Does multiple arterial coronary artery bypass grafting reduce long-term all-cause mortality and MACCE compared with percutaneous coronary intervention in patients with multivessel coronary artery disease?
Meta-Analysis
Does multiple arterial coronary artery bypass grafting reduce long-term all-cause mortality and MACCE compared with percutaneous coronary intervention in patients with multivessel coronary artery disease?
In patients with multivessel coronary artery disease, multiple arterial CABG is associated with significantly lower long-term all-cause mortality and MACCE compared with PCI, supporting its consideration during heart team discussions.
Answers are grounded in this paper and cite their sources.
Multiple arterial CABG was associated with lower mortality than PCI; leaves open confirmation by randomized trials before practice change.
Background Multiple arterial coronary artery bypass grafting (CABG) has been associated with superior long-term outcomes compared with single arterial CABG. However, randomized trials comparing percutaneous coronary intervention (PCI) with CABG have largely evaluated single arterial grafting strategies, leaving evidence comparing multiple arterial CABG with PCI limited. Methods This systematic review and meta-analysis was registered prospectively in PROSPERO (CRD42025106759). MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies published from inception through September 30, 2025, that compared outcomes between multiple arterial CABG and PCI in patients with multivessel coronary artery disease. Study-level meta-analyses and reconstructed individual patient data (IPD) meta-analyses were performed. The primary outcome was all-cause mortality, and the secondary outcome was major adverse cardiovascular and cerebrovascular events (MACCE). Results Ten observational studies were included. Study-level meta-analysis showed higher all-cause mortality with PCI (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.51-2.09), consistent with reconstructed IPD analysis (HR 2.05, 95% CI 1.86-2.27). PCI was also associated with increased MACCE (study-level HR 2.48, 95% CI 1.91-3.21; IPD HR 2.94, 95% CI 2.56-3.39). Conclusion In multivessel coronary artery disease, multiple arterial CABG was associated with significantly lower long-term mortality and MACCE than PCI, supporting its consideration in heart team decision-making.
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Nishida et al. (2026) conducted a meta-analysis in Multivessel coronary artery disease. Percutaneous coronary intervention (PCI) vs. Multiple arterial coronary artery bypass grafting (CABG) was evaluated on All-cause mortality (HR 1.78, 95% CI 1.51-2.09). Percutaneous coronary intervention was associated with higher all-cause mortality than multiple arterial CABG in multivessel coronary artery disease (study-level HR 1.78; 95% CI 1.51-2.09).
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