Abstract 4341: Percutaneous Coronary Intervention With Drug-Eluting Stents versus Coronary Artery Bypass Surgery for Multivessel Coronary Artery Disease: A Meta-Analysis of Available Data From the ARTS II, SYNTAX, CARDia and ERACI III Studies and a Review of the Literature
Background: Data from prospective, randomized trials comparing drug-eluting stent (DES) placement to coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease are beginning to appear in the literature. The goal of this study was to systematically analyze the available data from trials comparing revascularization by DES placement versus CABG.
Methods: We searched Medline and PubMed and internet sources of information for
trials comparing DES placement to CABG in
patients with multivessel coronary artery disease. There were no restrictions on journal type or population studied.
Results: Four prospective, randomized studies were included which enrolled a total of 3,895 patients: 1,914 in the DES arm and 1,981 patients in the CABG arm. Pooled analysis of data from these 4 studies shows that in patients treated DES stent compared to CABG there was a similar risk of the combined endpoints of death, myocardial infarction and stroke (8.7% versus 9.7%, respectively; RR=0.90 [95% CI=0.74 –1. −9]; p=0.28), a significantly higher risk of target vessel revascularization (TVR) (12.9% verus 5/6%, respectively; RR=2.26 [95% CI=1.82–2.80]; <0.001) and, therefore, significantly higher risk of MACCE (18.5% verus 14.2%, respectively; RR=1.27 [95% CI=1.06 –1.52]; p=0.008). We identified 11 observational studies which evaluated DES placement versus CABG in 17,769 patients with multivessel disease. DES placement is associated with a higher risk MACCE (7% versus 5%, respectively; RR=1.78 [95% CI=1.24 –2.55]; p=0.002); but significantly lower risk of stroke (0.7% versus 1.4%, respectively; RR=0.56 [95% CI=0.33– 0.96]; p=0.03).
Conclusions: This analysis of available data from prospective randomized studies suggests that DES placement in multivessel disease is associated with a decreased risk of stroke, higher risk for TVR and similar risk of death and myocardial infarction compared to CABG. Overall, PCI with DES placement is safe in patients with multivessel disease compared to CABG, but treatment must be individualized for each patient based on their pre-procedure co-morbidities and their understanding of procedural risks.