Advertisement

Meta-Analysis Comparing the Risk of Myocardial Infarction Following Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients With Multivessel or Left Main Coronary Artery Disease

  • Author Footnotes
    # The first two authors contributed equally to this article.
    Pil Hyung Lee
    Footnotes
    # The first two authors contributed equally to this article.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    # The first two authors contributed equally to this article.
    Hanbit Park
    Footnotes
    # The first two authors contributed equally to this article.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Ji Sung Lee
    Affiliations
    Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Seung-Whan Lee
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Cheol Whan Lee
    Correspondence
    Corresponding author: Tel: +82-2-3010-3150; fax: +82-2-486-5918.
    Affiliations
    Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    # The first two authors contributed equally to this article.
      There is insufficient data regarding the comparative efficacy of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) regarding myocardial infarction (MI). Our systematic review included randomized controlled trials that compared CABG versus PCI with stents in patients with multivessel or left main coronary artery disease (CAD). Included trials should have had reported event number of MI and a clinical follow-up of one or more years. Data were pooled using a random-effects model. The primary end point was MI at the longest available follow-up in the intention-to-treat population. Fifteen trials with a total of 13,592 patients treated with either CABG (n = 6,596) or PCI (n = 6,996) were included. After a weighted follow-up of 4.5 years, patients treated with CABG had a significantly lower risk of MI than those treated with PCI (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58 to 0.96, p = 0.024). The lower risk of MI with CABG as compared with PCI was more evident during a longer duration of follow-up (≥3 years, RR 0.69, 95% CI 0.52 to 0.91, p = 0.008; ≥5 years, RR 0.64, 95% CI 0.48 to 0.86, p = 0.003) and in the diabetic population (RR 0.55, 95% CI 0.44 to 0.70, p <0.001). The magnitude of risk reduction was similar across patients with multivessel (RR 0.72, 95% CI 0.53 to 0.99) and left main CAD (RR 0.74, 95% CI 0.47 to 1.15). In conclusion, the present meta-analysis of studies involving patients with multivessel or left main CAD suggests a significant benefit of CABG over PCI concerning the risk of future MI.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Head SJ
        • Milojevic M
        • Daemen J
        • Ahn JM
        • Boersma E
        • Christiansen EH
        • Domanski MJ
        • Farkouh ME
        • Flather M
        • Fuster V
        • Hlatky MA
        • Holm NR
        • Hueb WA
        • Kamalesh M
        • Kim YH
        • Makikallio T
        • Mohr FW
        • Papageorgiou G
        • Park SJ
        • Rodriguez AE
        • Sabik 3rd, JF
        • Stables RH
        • Stone GW
        • Serruys PW
        • Kappetein AP
        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: 939-948
        • Al-Hijji M
        • El Sabbagh A
        • Holmes DR
        Revascularization for left main and multivessel coronary artery disease: current status and future prospects after the EXCEL and NOBLE Trials.
        Korean Circ J. 2018; 48: 447-462
        • Mohr FW
        • Morice MC
        • Kappetein AP
        • Feldman TE
        • Stahle E
        • Colombo A
        • Mack MJ
        • Holmes Jr., DR
        • Morel MA
        • Van Dyck N
        • Houle VM
        • Dawkins KD
        • Serruys PW
        Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial.
        Lancet. 2013; 381: 629-638
        • Farkouh ME
        • Domanski M
        • Dangas GD
        • Godoy LC
        • Mack MJ
        • Siami FS
        • Hamza TH
        • Shah B
        • Stefanini GG
        • Sidhu MS
        • Tanguay JF
        • Ramanathan K
        • Sharma SK
        • French J
        • Hueb W
        • Cohen DJ
        • Fuster V
        • investigators FF-Os
        Long-term survival following multivessel revascularization in patients with diabetes: the FREEDOM follow-on study.
        J Am Coll Cardiol. 2019; 73: 629-638
        • Stone GW
        • Sabik JF
        • Serruys PW
        • Simonton CA
        • Genereux P
        • Puskas J
        • Kandzari DE
        • Morice MC
        • Lembo N
        • Brown 3rd, WM
        • Taggart DP
        • Banning A
        • Merkely B
        • Horkay F
        • Boonstra PW
        • van Boven AJ
        • Ungi I
        • Bogats G
        • Mansour S
        • Noiseux N
        • Sabate M
        • Pomar J
        • Hickey M
        • Gershlick A
        • Buszman P
        • Bochenek A
        • Schampaert E
        • Page P
        • Dressler O
        • Kosmidou I
        • Mehran R
        • Pocock SJ
        • Kappetein AP
        • Investigators ET
        Everolimus-eluting stents or bypass surgery for left main coronary artery disease.
        N Engl J Med. 2016; 375: 2223-2235
        • Makikallio T
        • Holm NR
        • Lindsay M
        • Spence MS
        • Erglis A
        • Menown IB
        • Trovik T
        • Eskola M
        • Romppanen H
        • Kellerth T
        • Ravkilde J
        • Jensen LO
        • Kalinauskas G
        • Linder RB
        • Pentikainen M
        • Hervold A
        • Banning A
        • Zaman A
        • Cotton J
        • Eriksen E
        • Margus S
        • Sorensen HT
        • Nielsen PH
        • Niemela M
        • Kervinen K
        • Lassen JF
        • Maeng M
        • Oldroyd K
        • Berg G
        • Walsh SJ
        • Hanratty CG
        • Kumsars I
        • Stradins P
        • Steigen TK
        • Frobert O
        • Graham AN
        • Endresen PC
        • Corbascio M
        • Kajander O
        • Trivedi U
        • Hartikainen J
        • Anttila V
        • Hildick-Smith D
        • Thuesen L
        • Christiansen EH
        • investigators Ns
        Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial.
        Lancet. 2016; 388: 2743-2752
        • Anderson JL
        • Morrow DA
        Acute myocardial infarction.
        N Engl J Med. 2017; 376: 2053-2064
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman DG
        • Group P
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        BMJ. 2009; 339: b2535
        • Higgins JP
        • Altman DG
        • Gotzsche PC
        • Juni P
        • Moher D
        • Oxman AD
        • Savovic J
        • Schulz KF
        • Weeks L
        • Sterne JA
        • Cochrane Bias Methods G, Cochrane Statistical Methods G
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Deb S
        • Wijeysundera HC
        • Ko DT
        • Tsubota H
        • Hill S
        • Fremes SE
        Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review.
        JAMA. 2013; 310: 2086-2095
        • Serghiou S
        • Goodman SN
        Random-effects meta-analysis: summarizing evidence with caveats.
        JAMA. 2019; 321: 301-302
        • Kamalesh M
        • Sharp TG
        • Tang XC
        • Shunk K
        • Ward HB
        • Walsh J
        • King 3rd, S
        • Colling C
        • Moritz T
        • Stroupe K
        • Reda D
        • Investigators VC
        Percutaneous coronary intervention versus coronary bypass surgery in United States veterans with diabetes.
        J Am Coll Cardiol. 2013; 61: 808-816
        • So SI
        Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery trial): a randomised controlled trial.
        Lancet. 2002; 360: 965-970
        • Booth J
        • Clayton T
        • Pepper J
        • Nugara F
        • Flather M
        • Sigwart U
        • Stables RH
        • So SI
        Randomized, controlled trial of coronary artery bypass surgery versus percutaneous coronary intervention in patients with multivessel coronary artery disease: six-year follow-up from the Stent or Surgery Trial (SoS).
        Circulation. 2008; 118: 381-388
        • Buszman PE
        • Buszman PP
        • Banasiewicz-Szkrobka I
        • Milewski KP
        • Zurakowski A
        • Orlik B
        • Konkolewska M
        • Trela B
        • Janas A
        • Martin JL
        • Kiesz RS
        • Bochenek A
        Left main stenting in comparison with surgical revascularization: 10-year outcomes of the (Left Main Coronary Artery Stenting) LE MANS Trial.
        JACC Cardiovasc Interv. 2016; 9: 318-327
        • Boudriot E
        • Thiele H
        • Walther T
        • Liebetrau C
        • Boeckstegers P
        • Pohl T
        • Reichart B
        • Mudra H
        • Beier F
        • Gansera B
        • Neumann FJ
        • Gick M
        • Zietak T
        • Desch S
        • Schuler G
        • Mohr FW
        Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis.
        J Am Coll Cardiol. 2011; 57: 538-545
        • Ahn JM
        • Roh JH
        • Kim YH
        • Park DW
        • Yun SC
        • Lee PH
        • Chang M
        • Park HW
        • Lee SW
        • Lee CW
        • Park SW
        • Choo SJ
        • Chung C
        • Lee J
        • Lim DS
        • Rha SW
        • Lee SG
        • Gwon HC
        • Kim HS
        • Chae IH
        • Jang Y
        • Jeong MH
        • Tahk SJ
        • Seung KB
        • Park SJ
        Randomized trial of stents versus bypass surgery for left main coronary artery disease: 5-year outcomes of the PRECOMBAT Study.
        J Am Coll Cardiol. 2015; 65: 2198-2206
        • Bangalore S
        • Guo Y
        • Samadashvili Z
        • Blecker S
        • Hannan EL
        Revascularization in patients with multivessel coronary artery disease and severe left ventricular systolic dysfunction: everolimus-eluting stents versus coronary artery bypass graft surgery.
        Circulation. 2016; 133: 2132-2140
        • Lee PH
        • Lee JY
        • Lee CW
        • Han S
        • Ahn JM
        • Park DW
        • Kang SJ
        • Lee SW
        • Kim YH
        • Park SW
        • Park SJ
        Long-term outcomes of bypass grafting versus drug-eluting stenting for left main coronary artery disease: Results from the IRIS-MAIN registry.
        Am Heart J. 2017; 193: 76-83
        • Chang M
        • Lee CW
        • Ahn JM
        • Cavalcante R
        • Sotomi Y
        • Onuma Y
        • Zeng Y
        • Park DW
        • Kang SJ
        • Lee SW
        • Kim YH
        • Park SW
        • Serruys PW
        • Park SJ
        Coronary artery bypass grafting versus drug-eluting stents implantation for previous myocardial infarction.
        Am J Cardiol. 2016; 118: 17-22
        • Velazquez EJ
        • Lee KL
        • Jones RH
        • Al-Khalidi HR
        • Hill JA
        • Panza JA
        • Michler RE
        • Bonow RO
        • Doenst T
        • Petrie MC
        • Oh JK
        • She L
        • Moore VL
        • Desvigne-Nickens P
        • Sopko G
        • Rouleau JL
        • Investigators S
        Coronary-artery bypass surgery in patients with ischemic cardiomyopathy.
        N Engl J Med. 2016; 374: 1511-1520
        • Palmerini T
        • Serruys P
        • Kappetein AP
        • Genereux P
        • Riva DD
        • Reggiani LB
        • Christiansen EH
        • Holm NR
        • Thuesen L
        • Makikallio T
        • Morice MC
        • Ahn JM
        • Park SJ
        • Thiele H
        • Boudriot E
        • Sabatino M
        • Romanello M
        • Biondi-Zoccai G
        • Cavalcante R
        • Sabik JF
        • Stone GW
        Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: a meta-analysis of 6 randomized trials and 4,686 patients.
        Am Heart J. 2017; 190: 54-63
        • Smit Y
        • Vlayen J
        • Koppenaal H
        • Eefting F
        • Kappetein AP
        • Mariani MA
        Percutaneous coronary invervention versus coronary artery bypass grafting: a meta-analysis.
        J Thorac Cardiovasc Surg. 2015; 149 (831-838 e831-813)
        • Palmerini T
        • Biondi-Zoccai G
        • Della Riva D
        • Stettler C
        • Sangiorgi D
        • D'Ascenzo F
        • Kimura T
        • Briguori C
        • Sabate M
        • Kim HS
        • De Waha A
        • Kedhi E
        • Smits PC
        • Kaiser C
        • Sardella G
        • Marullo A
        • Kirtane AJ
        • Leon MB
        • Stone GW
        Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis.
        Lancet. 2012; 379: 1393-1402
        • Hong SJ
        • Kim BK
        • Shin DH
        • Nam CM
        • Kim JS
        • Ko YG
        • Choi D
        • Kang TS
        • Kang WC
        • Her AY
        • Kim YH
        • Hur SH
        • Hong BK
        • Kwon H
        • Jang Y
        • Hong MK
        • Investigators I-X
        Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial.
        JAMA. 2015; 314: 2155-2163
        • Blackstone EH
        • Sabik 3rd, JF
        Changing the discussion about on-pump versus off-pump CABG.
        N Engl J Med. 2017; 377: 692-693
        • Thygesen K
        • Alpert JS
        • White HD
        • Joint ESCAAHAWHFTFftRoMI
        Universal definition of myocardial infarction.
        J Am Coll Cardiol. 2007; 50: 2173-2195
        • Thygesen K
        • Alpert JS
        • Jaffe AS
        • Simoons ML
        • Chaitman BR
        • White HD
        • Joint ESCAAHAWHFTFfUDoMI, Authors/Task Force Members C, Thygesen K, Alpert JS, White HD, Biomarker S, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Subcommittee ECG, Chaitman BR, Clemmensen PM, Johanson P, Hod H, Imaging S, Underwood R, Bax JJ, Bonow JJ, Pinto F, Gibbons RJ, Classification S, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Intervention S, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J, Trials, Registries S, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Trials, Registries S, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Trials, Registries S, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Trials, Registries S, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Guidelines ESCCfP, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Document R, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Botker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR
        Third universal definition of myocardial infarction.
        J Am Coll Cardiol. 2012; 60: 1581-1598
        • Moussa ID
        • Klein LW
        • Shah B
        • Mehran R
        • Mack MJ
        • Brilakis ES
        • Reilly JP
        • Zoghbi G
        • Holper E
        • Stone GW
        Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI).
        J Am Coll Cardiol. 2013; 62: 1563-1570
        • Spitzer E
        • McFadden E
        • Vranckx P
        • Garcia-Garcia HM
        • Seltzer JH
        • Held C
        • de Vries T
        • Menon V
        • Brown KJ
        • Soliman OII
        • Onuma Y
        • Lopes RD
        • Stone GW
        • Cutlip DE
        • Serruys PW
        Critical appraisal of contemporary clinical endpoint definitions in coronary intervention trials: a guidance document.
        JACC Cardiovasc Interv. 2019; 12: 805-819