Outcomes better with CABG than PCI in patients with diabetes or multivessel disease

Référence

Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 2018;391(10124):939-948.

Sommaire

These authors obtained patient-level data from 11 randomized controlled trials that compared CABG (n = 5765) and PCI (n = 5753) in patients with left main coronary artery disease or multivessel disease. The interventions could not have been part of managing patients with acute myocardial infarctions. The included studies had at least 12 months of follow-up and assessed all-cause mortality. After pooling all the data, the overall 5-year mortality rate was lower for patients undergoing CABG (9.2% vs 11.2% for PCI; number needed to treat [NNT] = 50) with the separation of mortality rate not being evident until 2 years after the procedures. Furthermore, patients with diabetes had lower 5-year mortality rates when treated by CABG than PCI (10.7% vs. 15.7%; NNT = 20), though the researchers found no mortality difference in patients without diabetes. For patients with multivessel disease, those treated with CABG also had lower 5-year mortality rates (8.9% vs 11.5% for PCI; NNT = 39). The 5-year mortality for CABG and PCI was similar in patients with left main disease. The authors don't report on complications, recovery, or quality of life. This information, combined with the mortality data, should be presented to patients faced with this decision. None of the studies compared the interventions with medical therapy, and it is unclear how many of the patients in these studies had stable coronary artery disease. We have reported multiple studies for approximately 20 years that have shown that mortality and cardiac events are comparable for patients with stable angina who are treated medically, with PCI, or with CABG.