Outcomes of CABG Versus PCI for Coronary Revascularization.
Outcomes of CABG Versus PCI for Coronary Revascularization.
| Year | Study | Result | Notes |
|---|---|---|---|
| 2009 | SYNTAX62 | Lower MACCE with CABG rates in patients with severe coronary disease as defined by SYNTAX score | Supports CABG as the standard of care for patients with 3-vessel disease or complex left main CAD |
| 2011 | PRECOMBAT63 | PCI with sirolimus-eluting stents was non-inferior to CABG in patients with unprotected left main CAD with respect to MACCE at 1 year | Both groups had similar rates of death/MI/stroke. Occurrence of ischemia-driven, target-vessel revascularization at 2 years was lower in CABG than PCI |
| 2011 | STITCH64 | Compared conservative treatment with medical therapy vs. medical therapy + CABG in patients with CAD and LV dysfunction. No significant differences in all-cause mortality, though rate of cardiac-cause hospitalization was lower with CABG | 10-year follow-up, reported in 2019, concluded that CABG reduces all-cause mortality, and cardiovascular and heart failure hospitalizations71 |
| 2012 | ASCERT65 | No significant difference in mortality between patients ≥65 years with 2- or 3-vessel disease undergoing CABG vs. PCI at 1 year. Lower mortality with CABG than PCI at 4-year follow-up | |
| 2012 | FREEDOM66 | CABG superior to PCI in patients with diabetes and multivessel disease; signifi-cantly reduced death and MI at 5 years | Some increased risk of strokes in the CABG group |
| 2015 | BEST67 | For multivessel CAD patients, higher MACE in PCI vs. CABG group; higher spontaneous MI and repeat revasculariza-tion after PCI vs. CABG | Similar comparison to FREEDOM trial |
| 2019 | EXCEL68 | At 5 years, no significant difference in death/stroke/MI between PCI and CABG patients with left main CAD of low or intermediate anatomical complexity | Some methodological controversy:72 incidence of all-cause mortality significantly higher in PCI group at 5 years, but all-cause mortality classified as a secondary not primary endpoint. Repeat revascu-larization was significantly higher in PCI vs. CABG groups (also not a primary endpoint). Occurrence of composite death, stroke, MI score shifted from favoring PCI to favoring CABG after 30-days’ follow-up, which may indicate CABG is preferred in patients with a higher life expectancy |
| 2020 | NOBLE69 | PCI had inferior 5-year clinical outcomes in patients with left main disease as compared with CABG | Both procedures had similar rates of mortality, but PCI had higher rates of repeat revascularization and of non-procedural MI |
| 2022 | FAME III70 | Examined whether FFR-guided PCI was non-inferior to CABG in 1-year composite outcome (death, MI, stroke, or repeat revascularization) in patients with 3-vessel disease. The study did not show non-inferiority, and CABG resulted in lower incidence of composite outcome | 30-day CABG mortality was 0.3%, identical to that of PCI |
| 2023 | Meta-analysis of Randomized Trials73 | During 5-year follow-up, PCI showed higher incidence of all-cause mortality, MI, and repeat coronary revascularization | Meta-analysis comparing CABG and PCI for treatment of left main or multivessel disease
Elevated risk of stroke in 30-day post-operative period for CABG, but no long-term difference at 5-year follow-up |
CABG, coronary artery bypass graft; CAD, coronary artery disease; FFR, fractional flow reserve; LV, left ventricle/ventricular; MACCE, major adverse cardiovascular and cerebrovascular events; MACE, major adverse cardiovascular events; MI, myocardial infarction; PCI, percutaneous coronary intervention.