A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes

We performed a meta-analysis of randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous transluminal coronary angioplasty (PTCA) for the treatment of coronary artery disease, incorporating new trials and examining long-term outcomes. Previous meta-analyses of trials...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2003-04, Vol.41 (8), p.1293-1304
Main Authors: Hoffman, Stuart N., TenBrook, John A., Wolf, Michael P., Wong, John B., Pauker, Stephen G., Salem, Deeb N.
Format: Article
Language:English
Subjects:
Angioplasty
Angioplasty, Balloon, Coronary - mortality
Biological and medical sciences
Cardiology
Coronary Artery Bypass - mortality
Coronary Disease - mortality
Coronary Disease - surgery
Coronary Disease - therapy
Coronary vessels
Drug therapy
Heart attacks
Humans
Medical sciences
Randomized Controlled Trials as Topic
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Survival Analysis
Time Factors
Treatment Outcome
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Summary:We performed a meta-analysis of randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous transluminal coronary angioplasty (PTCA) for the treatment of coronary artery disease, incorporating new trials and examining long-term outcomes. Previous meta-analyses of trials comparing CABG with PTCA have reported short- and intermediate-term outcomes, but since then longer term follow-up and newer trials have been published. We performed a meta-analysis of 13 randomized trials on 7,964 patients comparing PTCA with CABG. We found a 1.9% absolute survival advantage favoring CABG over PTCA for all trials at five years (p < 0.02), but no significant advantage at one, three, or eight years. In subgroup analysis of multivessel disease, CABG provided significant survival advantage at both five and eight years. Patients randomized to PTCA had more repeat revascularizations at all time points (risk difference [RD] 24% to 38%, p < 0.001); with stents, this RD was reduced to 15% at one and three years. Stents also resulted in a significant decrease in nonfatal myocardial infarction at three years when compared with CABG. For diabetic patients, CABG provided a significant survival advantage over PTCA at 4 years but not at 6.5 years. Our results suggest that, when compared with PTCA, CABG is associated with a lower five-year mortality, less angina, and fewer revascularization procedures. For patients with multivessel disease, CABG provided a survival advantage at five to eight years, and for diabetics, a survival advantage at four years. The addition of stents reduced the need for repeat revascularization by about half.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(03)00157-8