A new analysis of old data supports further discussion on the hot debate as to the best revascularization strategy in patients with multivessel coronary artery disease. Authors pooled individual patient data from ten randomised trials to compare the effectiveness of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) according to patients’ baseline clinical characteristics. Importantly, PCI was done with balloon angioplasty in six trials and with bare-metal stents in four trials.
Over a median follow-up of 5.9 years (IQR 5.0–10.0), 575 (15%) of 3889 patients assigned to CABG died compared with 628 (16%) of 3923 patients assigned to PCI (hazard ratio [HR] 0.91, 95% CI 0.82–1.02; p=0.12). In patients with diabetes (CABG, n=615; PCI, n=618), mortality was substantially lower in the CABG group than in the PCI group (HR 0.70, 0.56–0.87); however, mortality was similar between groups in patients without diabetes (HR 0.98, 0.86–1.12; p=0.014 for interaction). Patient age modified the effect of treatment on mortality, with hazard ratios of 1.25 (0.94–1.66) in patients younger than 55 years, 0.90 (0.75–1.09) in patients aged 55–64 years, and 0.82 (0.70–0.97) in patients 65 years and older (p=0.002 for interaction). Treatment effect was not modified by the number of diseased vessels or other baseline characteristics.
Subgroup analyses for mortality after treatment with coronary artery bypass graft or percutaneous coronary intervention