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.