For patients with coronary artery disease, is percutaneous coronary intervention (PCI) comparable to coronary artery bypass graft in reducing morality?

Results of the SYNTAX Trial and Recent Systematic Review of 10 RCTs

Serruys PW, Morice M-C, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-972.

Objective: To compare PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both)

Metods: Multi-site clinical trial where 1800 consecutive patients with previously untreated coronary disease determined by local interventional cardiologist and cardiac surgeon. Eligible patients randomized in stratified groups (presence or absence of left main disease and presence or absence of medically treated diabetes) at each site. Significantly more patients in the PCI group had blood pressure of 130/80 or more, while more patients in the CABG group were current smokers, had elevated triglyceride levels and reduced HDL levels. Table 1 summarizes patient characteristics. Table 2 summarizes differences in cardiac-related medications given to patients in each group.

Patients were followed up for 12 months for composite outcome of death from any cause, stroke, myocardial infarction, or repeat revascularization.

Results: Figure 2 displays rates of outcomes for each of the groups. There were significant differences in rates of repeat revascularization and major cardiac or cerebrovascular events. The PCI group have an increased relative risk of 2.29 (95% CI, 1.67 to 3.14) for repeat revascularization and 1.44 (95% CI, 1.15 to 1.81) for major cardiac or cerebrovascular events.

Systematic Review

Hlatky MA, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009 Apr 4;373(9670):1190-7.

Objective: To assess whether the effects of PCI and CABG on mortality are modified by patient characteristics.

Methods: Searched Medline, Embase, and Cochrane databases for studies published between January, 1966, and August, 2006, as well as reviewing tables of contents, review articles and conference proceedings.

Included RCTs in any language that randomized patients to either PCI or CABG with a minimum follow-up of three years. Authors from 10 of 12 identified trials agreed to provide individual patient data for meta-analysis (N=7,812).

Results: Fig 2 (p. 1193) is a meta-analysis of mortality risk for CABG and PCI by patient demographics and cardiac findings. Figures 3 and 4 show mortality in each treatment arm by patient age and diabetes status. Overall 5-year mortality risk was similar for PCI and CABG in most of the groups examined. Older patients and patients with diabetes appeared to have significantly lower mortality with CABG than with PCI.

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About Amy

Clinical Informationist at EUH Branch Library
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