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A Journal on Heart and Vascular Diseases
Official Journal of the Italian Society of Angiology and Vascular Pathology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,752
Minerva Cardioangiologica 2008 October;56(5):453-60
Meta-analysis of 5-year outcomes of CABG vs PCI with stenting in patients with multivessel disease
Athappan G. 1, Vinodhkumaradithyaa A. 2, Srinivasan M. 2, Jeyaseelan L. 3, Ponniah T. 2
1 Caritas St Elizabeth Medical Center Tufts School of Medicine, Boston, MA, USA
2 Madurai Medical College, Madurai, India
3 Christian Medical College, Vellore , India
Aim. The purpose of this meta-analysis was to systematically review and synthesize existing data on long term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with multiple stenting in patients with multivessel coronary artery disease.
Methods. Three randomized control trials of CABG versus stenting with a 5-year follow-up and a total number of 2 063 patients were included in the meta-analysis. The primary end-point of the study was freedom from major adverse cardiovascular events at 5 years.
Results. After 5 years of follow-up, 42.81% of patients randomized to PCI with stenting versus 20.81% of patients randomized to CABG reached the primary clinical end-point(relative risk [RR] 2.16, 95% confidence interval [CI] 1.38-3.38). Repeat revascularization procedures occurred more frequently in patients allocated to PCI with multiple stenting compared with CABG (30.29% versus 7.45%, RR 4.47 and 95% CI 2.75-7.29). Non fatal myocardial infarction (MI) (6.6% versus 6.2%, RR 1.00 and 95% CI 0.58-1.70) was nearly equal in the two groups while deaths (9.3% versus 7.4%, RR 1.50 and 95% CI 0.61-3.66) were slightly higher in patients treated by PCI as compared to CABG.
Conclusion. Five years after the initial procedure, there is no survival benefit for CABG over PCI, but major adverse cardiovascular events and repeat revascularization procedures are high after PCI.