Review: CABG and percutaneous coronary intervention do not differ for long-term mortality in multivessel coronary artery disease

In patients with multivessel coronary artery disease (CAD), do patient characteristics modify the relative effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on long-term mortality?

Included studies compared CABG with PCI in patients with multivessel CAD. Outcomes were all-cause mortality overall and by subgroups of such patient characteristics as age, diabetes, history of myocardial infarction (MI), and angiographic factors.

MEDLINE, Cochrane databases, and EMBASE/Excerpta Medica (to Aug 2006); references; conference abstracts; and bibliographies of experts were searched for randomized controlled trials (RCTs) with follow-up ≥ 3 years. 12 RCTs met the selection criteria, and individual patient data were provided for 10 of these (n = 7812, median age 61 y, 77% men). PCI was done with balloon angioplasty in 6 trials (n = 4761) and bare-metal stents in 4 trials (n = 3051). Median duration of follow-up was 5.9 years.

Overall, CABG and PCI did not differ for mortality (Table). The only patient characteristics that modified treatment effect were diabetes (P = 0.014 for interaction) and age (P = 0.002 for interaction) (Table). Factors that did not modify treatment effect included sex, smoking, hypertension, cholesterol level, peripheral vascular disease, symptom stability, previous MI, heart failure, left ventricular function, number of diseased vessels, disease of the proximal left anterior descending coronary artery, and PCI method.

In patients with multivessel coronary artery disease, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have similar effects on long-term mortality. CABG may be more effective than PCI in patients with diabetes and those ≥ 65 years of age.