A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes.
OBJECTIVE
We performed a meta-analysis of randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous transluminal coronary angioplasty (PTCA) for the treatment of coronary artery disease, incorporating new trials and examining long-term outcomes.


BACKGROUND
Previous meta-analyses of trials comparing CABG with PTCA have reported short- and intermediate-term outcomes, but since then longer term follow-up and newer trials have been published.


METHODS
We performed a meta-analysis of 13 randomized trials on 7,964 patients comparing PTCA with CABG.


RESULTS
We found a 1.9% absolute survival advantage favoring CABG over PTCA for all trials at five years (p < 0.02), but no significant advantage at one, three, or eight years. In subgroup analysis of multivessel disease, CABG provided significant survival advantage at both five and eight years. Patients randomized to PTCA had more repeat revascularizations at all time points (risk difference [RD] 24% to 38%, p < 0.001); with stents, this RD was reduced to 15% at one and three years. Stents also resulted in a significant decrease in nonfatal myocardial infarction at three years when compared with CABG. For diabetic patients, CABG provided a significant survival advantage over PTCA at 4 years but not at 6.5 years.


CONCLUSIONS
Our results suggest that, when compared with PTCA, CABG is associated with a lower five-year mortality, less angina, and fewer revascularization procedures. For patients with multivessel disease, CABG provided a survival advantage at five to eight years, and for diabetics, a survival advantage at four years. The addition of stents reduced the need for repeat revascularization by about half.
Hoffman
Stuart N
SN
Department of Medicine, Division of Clinical Decision Making, Informatics, and Telemedicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
TenBrook
John A
JA
Wolf
Michael P
MP
Pauker
Stephen G
SG
Salem
Deeb N
DN
Wong
John B
JB
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D001026:Coronary Artery Bypass / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome