Abstract 16641: Coronary Artery Bypass Grafting vs. Percutaneous Coronary Intervention Using Drug-Eluting Stenting in Patients With Multivessel Coronary Artery Disease: A Meta-Analysis of Six Randomized Controlled Trials
Background: Percutaneous coronary intervention (PCI) and Coronary Artery Bypass Grafting (CABG) are established strategies for coronary revascularization in the setting of ischemic heart disease. The use of drug eluting stents (DES) improved outcome after PCI in the contemporary era. Multiple randomized controlled trials have compared outcomes of the two modalities in patients with multivessel coronary artery disease.
Methods: We did a meta-analysis from six randomized trials in the contemporary era comparing PCI with DES to CABG with a total of 5123 patients to compare the effectiveness of two strategies at 12 months. To study longer-term outcome we used data from 4 trials of 4498 patients to compare the outcomes at 1 and 2 years respectively and data from 3 trials of 4202 patients to compare outcomes at 1 and 5 years respectively.
Results: At 1 year PCI was associated with significant increase incidence in Target Vessel Revascularization (TVR) (11.59% vs. 4.79%; RR= 2.31; 95% CI: [1.80 - 2.96]; P=<0.0001), lower incidence of stroke (0.55% vs. 1.86%; RR= 0.35; 95% CI: [0.19 - 0.62]; P=0.0003), and no difference in either death (3.70% vs. 3.63%; RR= 1.02; 95% CI: [0.77 - 1.36]; P= 0.8783) or MI (4.54% vs. 3.29%; RR= 1.16; 95% CI: [0.72 - 1.88]; P= 0.5319). At 2 years PCI was still associated with lower incidence of stroke , no increase in the incidence of either death or MI. At 5 years PCI was still associated with lower incidence of stroke, but with a significant increase incidence of death (12.99% vs. 9.99%; RR= 1.3; 95% CI: [1.10 - 1.54]; P= 0.0026) and MI (10.28% vs. 4.63%; RR= 2.21; 95% CI: [1.75 - 2.79]; P=<0.0001).
Conclusion: In patients with multi-vessel coronary artery disease PCI is associated with no-significant difference in death and MI at 1 and 2 years respectively. However at 5 years PCI is associated with higher incidence of death and MI. PCI is associated with significant higher incidence of TVR and lower incidence of stroke when compared with CABG.
- © 2013 by American Heart Association, Inc.