Long-Term Mortality of 306,868 Patients with Multi-Vessel Coronary Artery Disease: CABG versus PCI
Jimmy T. Efird *
East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA and Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA and Center for Health Disparities Research, Brody School of Medicine, Greenville, NC, USA.
Wesley T. O’ Neal
East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA and Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA and Center for Health Disparities Research, Brody School of Medicine, Greenville, NC, USA.
Stephen W. Davies
East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA and Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA, and Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Whitney L. Kennedy
East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA and Center for Health Disparities Research, Brody School of Medicine, Greenville, NC, USA.
Lada N. Alger
Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Jason B. O’Neal
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
T. Bruce Ferguson
East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Alan P. Kypson
East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
*Author to whom correspondence should be addressed.
Abstract
Background: Several randomized controlled trials (RCT) have reported no difference in long-term mortality between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The purpose of this pooled observational analysis was to compare recent retrospective studies examining long-term survival of patients with multi-vessel coronary artery disease undergoing CABG and PCI.
Methodology: We searched Medline for observational studies comparing long-term (>1 year) survival between CABG and PCI for the treatment of multi-vessel coronary artery disease over the past 10 years.
Results: Eight studies met inclusion criteria. A total of 306,868 patients (155,502 CABG; 151,366 PCI) were identified. Follow-up ranged from 1 to 8 years. Mantel-Haenszel combined hazard ratios (HR) for mortality demonstrated a protective benefit of CABG compared with PCI (HR=0.77, 95%CI=0.75-0.79).
Conclusion: These findings suggest a long-term survival advantage for CABG compared with PCI in patients with multi-vessel coronary artery disease.
Keywords: CABG, PCI, survival, long-term