Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials

Umberto Benedetto*, Mario Gaudino, Colin Ng, Giuseppe Biondi-Zoccai, Fabrizio D'Ascenzo, Giacomo Frati, Leonard N. Girardi, Gianni D. Angelini, David P. Taggart

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

18 Citations (Scopus)

Abstract

Objective Current randomized controlled trials (RCTs) comparing percutaneous coronary intervention with drug eluting stent (DES-PCI) with coronary artery bypass grafting (CABG) in multivessel disease are underpowered to detect a difference in hard clinical end-points such as mortality, myocardial infarction and stroke. We aimed to overcome this limitation by conducting a meta-analysis of contemporary RCTs. Methods A systematic literature search was conducted for all RCTs comparing DES-PCI versus CABG in multivessel disease published through May 2015. Inverse variance weighting was used to pool data from individual studies (<1 favouring DES-PCI and > 1 CABG favouring surgery). Results A total of five randomized trials including 4563 subjects were analysed. After an average follow-up of 3.4 years, DES-PCI was associated with a significantly increased risk of overall mortality (HR 1.51; 95%CI 1.23-1.84; P <0.001), MI (HR 2.02; 95%CI 1.57-2.58; P <0.001) and repeat revascularization (HR 2.54; 95%CI 2.07-3.11; P = <0.001). CABG marginally increased the risk of stroke (HR 0.70; 95%CI 0.50-0.98; P = 0.04). The absolute risk reduction for all-cause mortality (3.3%) and myocardial infarction (4.3%) with CABG was larger than the absolute risk reduction for stroke (0.9%) with DES-PCI. Conclusion In patients with multivessel coronary disease, CABG was found to be superior to DES-PCI by reducing the risk of mortality and subsequent myocardial infarction at the expense of a marginally increased risk of stroke.

Original languageEnglish
Pages (from-to)19-24
Number of pages6
JournalInternational Journal of Cardiology
Volume210
Early online date18 Feb 2016
DOIs
Publication statusPublished - 1 May 2016

Structured keywords

  • Centre for Surgical Research

Keywords

  • CABG
  • Meta-analysis
  • PCI

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