Author + information
- Received September 10, 2002
- Revision received January 8, 2003
- Accepted January 16, 2003
- Published online April 16, 2003.
- ↵*Reprint requests and correspondence:
Dr. John B. Wong, Tufts-New England Medical Center, 750 Washington Street #302, Boston, Massachusetts 02111-1526, USA.
Objectives 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.
Background 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.
Methods We performed a meta-analysis of 13 randomized trials on 7,964 patients comparing PTCA with CABG.
Results 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.
Conclusions 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.
↵1 Dr. Wong was a co-investigator in the Patient Outcome Research Team grant for Ischemic Heart Disease from the then Agency for Health Care Policy and Research from 1990 to 1995 and is currently the content editor for Coronary Artery Disease for the nonprofit Foundation for Informed Medical Decision Making. In both of these cases he has complete independence from the funding source in study design, interpretation of data, report writing, and publication regardless of results.
Supported in part by grant LM07092-10 from the National Library of Medicine, Bethesda, Maryland, and by grant HS-06503 from the Agency for Healthcare Research and Quality, Rockville, Maryland.
- Received September 10, 2002.
- Revision received January 8, 2003.
- Accepted January 16, 2003.
- American College of Cardiology Foundation