percutaneous coronary intervention (PCI)/coronary stent vs CABG

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Introduction

Comparison of stent-assisted percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass graft (CABG).

Stent or Surgery Trial (SoS)[1]

Median follow-up 2 years

Results:

Outcomes similar with CABG & drug-eluting stent PCI[2]

CABG superior to stenting*[3] (studies did NOT include drug-eluting stents)

mortality similar after 1 year (PCI, 6.6%; CABG, 6.2%)

mortality at 4 years favors CABG (16.4% vs. 20.8%)[7]

CABG superior to drug-eluting stents in patients with diabetes mellitus[8]

CABG superior to PCI in older patients with multivessel disease[7][10]

CABG superior to PCI in patients amenable to bypass surgery with

stenting for left main coronary artery disease with similar outcomes to CABG:

5 year outcomes similar for composite outcomes of mortality & major cardiovascular event for left main coronary artery disease[19][26]

CABG with mortality benefit at 5 years vs PCI for patients with diabetes mellitus (HR=0.88) & those with a history of smoking [[[A26615|HR]]=0.82)[11]

PCI with slight mortality benefit at 5 years vs CABG for patients without a history of diabetes mellitus, smoking, peripheral artery disease or heart failure[11]

Patients are less likely to be compliant with their medications after CABG than after PCI[9]

Advantage to CABG for total mortality (RR=0.73), incident myocardial infarction (RR=0.58), & repeat revascularization (RR=0.29) for multivessel disease[14]

long-term mortality similar with CABG vs PCI with everolimus- eluting stent for non-diabetic patients with multivessel disease[15]

CABG superior to PCI with coronary stent in patients with multivessel disease &/or diabetes mellitus[16][18]

PCI may be preferable to CABG for single-vessel disease even in patients with diabetes mellitus

CABG may be preferable to PCU for ischemic cardiomyopathy with low LVEF[21]

Coronary revascularization declining in US, CABG more so than stenting[6]

Among older adults CABG vs PCI not different in post-procedural cognitive effects[22]

major cardiovascular events 1 year after procedure was higher with fractional flow reserve-guided PCI than with CABG[23]

Additional terms

References

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