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Outcomes better with CABG than PCI in patients with diabetes or multivessel disease
Clinical Question
Do patients have better outcomes with coronary bypass surgery than with percutaneous interventions?
Bottom line
Among patients undergoing invasive cardiac interventions without not having acute myocardial infarctions, the 5-year mortality rate in those with diabetes or with multivessel disease is better with coronary bypass surgery (CABG) than percutaneous interventions (PCI). This study does not address whether either intervention is superior to medical treatment. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
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.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Interesting that CABG appears to have better long term success than PCI in diabetics
My understanding of advances in cardiology over the last 40 years is that little has improved over CABG. Most of any improvement is due to Statins and ASA. Very little longterm benefit from Betablockers stents etc.
Good poem