Comparative Efficacy of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in the Treatment of Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials

Jordan Llerena-Velastegui, Kristina Zumbana-Podaneva, Sebastian Velastegui-Zurita, Melany Mejia-Mora, Juan Perez-Tomassetti, Allison Cabrera-Cruz, Pablo Haro-Arteaga, Ana Clara Fonseca Souza de Jesus, Pedro Moraes Coelho, Cristian Sanahuja-Montiel

Abstract


Background: Ischemic heart disease (IHD) is a major global health issue and a leading cause of death. This study compares the effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the management of IHD, focusing on their impact on revascularization, myocardial infarction (MI), and post-procedural stroke. This study aimed to evaluate and compare the effectiveness of PCI and CABG in treating IHD based on an exhaustive literature review of the past 5 years, emphasizing recent advancements and outcomes in IHD management.

Methods: A comprehensive literature review analyzed 32 randomized controlled trials (RCTs) retrieved from databases such as PubMed, Cochrane Library, and Google Scholar. The study specifically assessed the incidences of revascularization, stroke, and MI in patients treated with either PCI or CABG. The comparison between CABG and PCI exclusively focused on lesions with a SYNTAX score exceeding 32.

Results: Our findings highlight CABGs significant efficacy over PCI in reducing revascularization and MI. The aggregated Mantel-Haenszel (M-H) value for revascularization was 1.85 (95% confidence interval (CI): 1.65 - 2.07), signifying CABGs advantage. Additionally, CABG demonstrated superior performance in diminishing MI occurrences (M-H = 2.71, 95% CI: 1.13 - 6.53). In contrast, PCI was more effective in reducing stroke (M-H = 0.80, 95% CI: 0.60 - 1.10).

Conclusion: The study confirms CABGs superiority in reducing revascularization and MI in IHD patients, highlighting PCIs effectiveness in reducing stroke risk. These findings underscore the importance of personalized treatment strategies in IHD management and emphasize the need for ongoing research and evidence-based guidelines to aid in treatment selection for IHD patients.




Cardiol Res. 2024;15(3):153-168
doi: https://doi.org/10.14740/cr1638

Keywords


Ischemic heart disease; Revascularization; Percutaneous coronary intervention; Coronary artery bypass graft surgery; Meta-analysis

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