Meta-analysis of 5-year outcomes of CABG vs PCI with stenting in patients with multivessel disease.
OBJECTIVE
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.


CONCLUSIONS
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.
Athappan
G
G
Caritas St Elizabeth Medical Center, Tufts School of Medicine, Boston, MA 02135, USA. ganeshathappan@gmail.com
Vinodhkumaradithyaa
A
A
Srinivasan
M
M
Jeyaseelan
L
L
Ponniah
T
T
D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D013997:Time Factors