• Umberto Benedetto, Giovanni Melina, Emiliano Angeloni, Simone Refice, Antonino Roscitano, Brenno Fiorani, Gian Domenico Di Nucci, and Riccardo Sinatra.
• Cardiac Surgery Department, II School of Medicine, University of Rome La Sapienza, Policlinico S. Andrea, Via di Grottarossa 1039, Rome, Italy. u2benedetto@libero.it
• Eur J Cardiothorac Surg. 2009 Oct 1; 36 (4): 611-5.

ObjectiveCoronary artery bypass grafting (CABG) has been shown to provide better results than percutaneous coronary intervention (PCI) in multivessel coronary disease. Drug-eluting stents (DES) have significantly improved results of PCI in terms of restenosis but the advantages of such a treatment compared to CABG remain uncertain. This meta-analysis summarizes available data from observational cohorts comparing DES-PCI versus CABG.MethodsWe performed a systematic literature search for observational cohorts comparing CABG versus DES-PCI in patients with multivessel coronary disease. The mixed model method was used to obtain the pooled hazard ratio (HR) for outcomes of interest.ResultsA total of nine observational nonrandomized studies were identified and analyzed including a total of 24,268 patients with multivessel coronary disease who underwent DES-PCI (n=13,540) and CABG (n=10,728). Mean follow-up time was 20 months. Pooled analysis showed that DES-PCI and CABG were comparable in terms of composite occurrence of death, acute myocardial infarction and cerebrovascular accidents (HR=0.94; 95% CI=0.72-1.22; p=0.66). However, there was a significantly higher risk of repeat revascularization in the DES-PCI group (HR=4.06; 95% CI=2.64-6.24; p<0.001). Overall major adverse cardiac and cerebrovascular events rate in the DES-PCI was higher compared to the CABG group (HR=1.86; 95% CI=1.36-2.54; p<0.001).ConclusionsIn the 'real world' clinical practice, overall major adverse cardiac and cerebrovascular events rate continues to be higher after DES-PCI due to an excess of redo revascularization compared with CABG.

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