Coronary angioplasty versus CABG: review of randomized trials.
We carried out a review that included results of randomized trials that made a comparison between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The 25 selected trials involved 12,305 patients, 11,103 of whom were from studies in patients with multi-vessel disease and 1,212 were from studies in patients with single lesion of the left anterior descending (LAD). In the studies of multi-vessel disease patients, the PCI showed a trend towards lower early mortality (1.2% versus 2%) and lower incidence of stroke: 0.7% versus 1.65%. There was no difference in the intermediate mortality (3.8% versus 3.8%). There was a trend towards the superiority of CABG in late mortality (10.5% versus 9.6%). The difference was exclusively due to "balloon era" studies, with a trend towards an inversion in the "stent era" (9.6% versus 9.9%). In studies of single lesion of LAD, there was no significant difference in any endpoint. The aggregation of results from nine studies that assessed late mortality in diabetic patients showed a difference in favor of surgery (21.3% versus 15.9%). Two studies that evaluated main coronary artery disease did not show a significant difference in mortality at one year (3.9% versus 4.7%). The incidence of repeat revascularization was consistently higher in PCI, despite the progressive improvement in results in the stent era.
Serviço de Cardiologia, Hospital Universitário Walter Cantidio, Universidade Federal do Ceará. pedroneg@cardiol.br
Pedro José Negreiros de
PJ
Andrade
Marta Maria das Chagas
MM
Medeiros
Antonio Thomaz de
AT
Andrade
Antonio Augusto Guimarães
AA
Lima
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome