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

Research output: Contribution to journalArticle

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
DOIs
Publication statusPublished - May 1 2016

Fingerprint

Drug-Eluting Stents
Coronary Artery Bypass
Meta-Analysis
Randomized Controlled Trials
Stroke
Numbers Needed To Treat
Mortality
Myocardial Infarction
Percutaneous Coronary Intervention
Coronary Disease

Keywords

  • CABG
  • Meta-analysis
  • PCI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials. / Benedetto, Umberto; Gaudino, Mario; Ng, Colin; Biondi-Zoccai, Giuseppe; D'Ascenzo, Fabrizio; Frati, Giacomo; Girardi, Leonard N.; Angelini, Gianni D.; Taggart, David P.

In: International Journal of Cardiology, Vol. 210, 01.05.2016, p. 19-24.

Research output: Contribution to journalArticle

Benedetto, Umberto ; Gaudino, Mario ; Ng, Colin ; Biondi-Zoccai, Giuseppe ; D'Ascenzo, Fabrizio ; Frati, Giacomo ; Girardi, Leonard N. ; Angelini, Gianni D. ; Taggart, David P. / Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials. In: International Journal of Cardiology. 2016 ; Vol. 210. pp. 19-24.
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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.",
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AU - Benedetto, Umberto

AU - Gaudino, Mario

AU - Ng, Colin

AU - Biondi-Zoccai, Giuseppe

AU - D'Ascenzo, Fabrizio

AU - Frati, Giacomo

AU - Girardi, Leonard N.

AU - Angelini, Gianni D.

AU - Taggart, David P.

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N2 - 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.

AB - 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.

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