• Michal J Kawczynski, Andrea Gabrio, Jos G Maessen, van 't HofArnoud W JAWJCardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Department of Cardiology,, James M Brophy, Can Gollmann-Tepeköylü, Peyman Sardari Nia, Pieter A Vriesendorp, and Samuel Heuts.
• Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
• J. Thorac. Cardiovasc. Surg. 2024 Aug 20.

ObjectivesCoronary revascularization is frequently performed for coronary artery disease (CAD). This study aims to assess the totality of randomized evidence comparing percutaneous coronary intervention with drug-eluting stents (DES-PCI) to coronary artery bypass grafting (CABG) for CAD.MethodsA systematic search was applied to three electronic databases, including randomized trials comparing DES-PCI to CABG for CAD with 5-year follow-up. A Bayesian hierarchical meta-analytic model was applied. The primary outcome was all-cause mortality at five years; secondary outcomes were stroke, myocardial infarction, and repeat revascularization. Endpoints were reported in median relative risks (RR) and absolute risk differences (ARD), with 95% credible intervals (CrI). Kaplan-Meier curves were used to reconstruct individual patient data.ResultsSix studies comprising 8269 patients (DES-PCI n=4134, CABG n=4135) were included. All-cause mortality at 5 years was increased with DES-PCI (median RR 1.23 (95%CrI 1.01-1.45), with a median ARD of +2.3% (95%CrI 0.1-4.5%). For stroke, MI, and repeat revascularization, the median RRs were 0.79 (95%CrI 0.54-1.25), 1.84 (95%CrI 1.23-2.75), and 1.80 (95%CrI 1.51-2.16) for DES-PCI, respectively. In a sample of 1000 patients undergoing DES-PCI instead of CABG for CAD, a median of 23 additional deaths, 46 myocardial infarctions and 85 repeat revascularizations occurred at five years, while 10 strokes were prevented.ConclusionThe current data suggests a clinically relevant benefit of CABG over DES-PCI at five years, in terms of mortality, myocardial infarction, and repeat revascularization, despite an increased risk of stroke. These findings may guide the heart-team and the shared decision-making process.Copyright © 2024. Published by Elsevier Inc.

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