Home Forums Other Specialities Cardiothoracic Medicine & Surgery CABG vs PCI -LONG TERM MORT/MORB: IN MULTIVESSEL DISEASE.

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    Original Investigation | February 2014

    Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention and Long-term Mortality and Morbidity in Multivessel Disease
    Meta-analysis of Randomized Clinical Trials of the Arterial Grafting and Stenting Era

    JAMA Intern Med. 2014;174(2):223-230. doi:10.1001/jamainternmed.2013.12844. Text Size: A A A

    Importance

    Recent trials of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) for multivessel disease were not designed to detect a difference in mortality and therefore were underpowered for this outcome.

    Consequently, the comparative effects of these 2 revascularization methods on long-term mortality are still unclear. In the absence of solid evidence for mortality difference, PCI is oftentimes preferred over CABG in these patients, given its less invasive nature.

    Objectives

    To determine the comparative effects of CABG vs PCI on long-term mortality and morbidity by performing a meta-analysis of all randomized clinical trials of the current era that compared the 2 treatment techniques in patients with multivessel disease.

    Data Sources A systematic literature search was conducted for all randomized clinical trials directly comparing CABG with PCI.

    Study Selection
    To reflect current practice, we included randomized trials with 1 or more arterial grafts used in at least 90%, and 1 or more stents used in at least 70% of the cases that reported outcomes in patients with multivessel disease.

    Data Extraction Numbers of events at the longest possible follow-up and sample sizes were extracted.

    Data Synthesis

    A total of 6 randomized trials enrolling a total of 6055 patients were included, with a weighted average follow-up of 4.1 years. There was a significant reduction in total mortality with CABG compared with PCI (I2?=?0%; risk ratio [RR], 0.73 [95% CI, 0.62-0.86]) (P?

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