Which Revascularization Strategy Is Best, and for Whom? Results from a Pooled Analysis

For patients with multivessel disease, coronary-artery bypass grafting resulted in greater survival, with the greatest benefit in those with diabetes and complex coronary disease.

Most studies comparing coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease (CAD) have been underpowered for measuring mortality. In a pooled analysis of individual patient data, investigators compared 5753 PCI patients with 5765 CABG patients with multivessel or left main (LM) disease (mean age, 64; 24% women). A left internal mammary artery bypass was used in 96% of CABG surgeries; drug-eluting stents were used in 73% of PCI procedures.

At 5 years, all-cause mortality was higher with PCI than with CABG (11.2% vs. 9.2%; hazard ratio, 1.20). There was no interaction between stent type and the treatment effect. The difference in mortality emerged after about 2…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)