Comparison of percutaneous coronary intervention with drug eluting stents versus coronary artery bypass grafting in patients with multivessel coronary artery disease: Meta-analysis of six randomized controlled trials

ObjectiveTo compare outcomes of percutaneous coronary intervention (PCI) with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG) in patients with multivessel Coronary Artery Disease (CAD) using data from randomized controlled trials (RCT).BackgroundPCI and CABG are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple RCTs have compared outcomes of the two modalities in patients with multivessel CAD.MethodsWe did a meta-analysis from six RCTs in the contemporary era comparing the effectiveness of PCI with DES to at 1 year, 2 years and 5 years respectively.ResultsCompared to CABG, at one year PCI was associated with a significantly higher incidence of TVR (RR = 2.31; 95% CI: [1.80–2.96]; P = < 0.0001), lower incidence of stroke (RR = 0.35; 95% CI: [0.19–0.62]; P = 0.0003), and no difference in death (RR = 1.02; 95% CI: [0.77–1.36]; P = 0.88) or MI (RR = 1.16; 95% CI: [0.72–1.88]; P = 0.53). At 5 years, PCI was associated with a higher incidence of death (RR = 1.3; 95% CI: [1.10–1.54]; P = 0.0026) and MI (RR = 2.21; 95% CI: [1.75–2.79]; P = < 0.0001). While the higher incidence of MI with PCI was noticed in both diabetic and non-diabetics, death was increased mainly in diabetic patients.ConclusionIn patients with multi-vessel CAD, PCI with DES is associated with no significant difference in death or MI at 1 or 2 years. However at 5 years, PCI is associated with higher incidence of death and MI.