Coronary artery bypass grafting versus drug-eluting stents in multivessel coronary disease. A meta-analysis on 24,268 patients.
OBJECTIVE
Coronary artery bypass grafting (CABG) has been shown to provide better results than percutaneous coronary intervention (PCI) in multivessel coronary disease. Drug-eluting stents (DES) have significantly improved results of PCI in terms of restenosis but the advantages of such a treatment compared to CABG remain uncertain. This meta-analysis summarizes available data from observational cohorts comparing DES-PCI versus CABG.


METHODS
We performed a systematic literature search for observational cohorts comparing CABG versus DES-PCI in patients with multivessel coronary disease. The mixed model method was used to obtain the pooled hazard ratio (HR) for outcomes of interest.


RESULTS
A total of nine observational nonrandomized studies were identified and analyzed including a total of 24,268 patients with multivessel coronary disease who underwent DES-PCI (n=13,540) and CABG (n=10,728). Mean follow-up time was 20 months. Pooled analysis showed that DES-PCI and CABG were comparable in terms of composite occurrence of death, acute myocardial infarction and cerebrovascular accidents (HR=0.94; 95% CI=0.72-1.22; p=0.66). However, there was a significantly higher risk of repeat revascularization in the DES-PCI group (HR=4.06; 95% CI=2.64-6.24; p<0.001). Overall major adverse cardiac and cerebrovascular events rate in the DES-PCI was higher compared to the CABG group (HR=1.86; 95% CI=1.36-2.54; p<0.001).


CONCLUSIONS
In the 'real world' clinical practice, overall major adverse cardiac and cerebrovascular events rate continues to be higher after DES-PCI due to an excess of redo revascularization compared with CABG.
Benedetto
Umberto
U
Cardiac Surgery Department, II School of Medicine, University of Rome La Sapienza, Policlinico S. Andrea, Via di Grottarossa 1039, Rome, Italy. u2benedetto@libero.it
Melina
Giovanni
G
Angeloni
Emiliano
E
Refice
Simone
S
Roscitano
Antonino
A
Fiorani
Brenno
B
Di Nucci
Gian Domenico
GD
Sinatra
Riccardo
R
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D023903:Coronary Restenosis / Q000628:therapy; D054855:Drug-Eluting Stents; D005500:Follow-Up Studies; D006801:Humans