Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

Background: Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MI). However, CABG benefits are unclear in patients with chronic total occlusion (CTO), where PCI has been used increasingly as a less-invasive alternative.

Methods: We performed a meta-analysis of studies comparing outcomes in patients with CTO with/without multivessel disease, who underwent CABG or PCI. Primary outcome was long-term all-cause mortality (≥5 years). Secondary outcomes were long-term MI, repeat revascularization, cardiac mortality, major adverse cardiovascular events, and stroke, as well as short-term mortality (30-days/in-hospital) and short-term stroke. A pooled Kaplan-Meier survival curve after reconstruction analysis was generated. Random-effects models were used.

Results: Seven studies with 14,196 patients were included. In the pooled Kaplan-Meier analysis CABG showed significantly lower risk of death in the follow-up compared to PCI (HR = 2.08, 95% CI, 1.86–2.34, p < 0.001). CABG was also associated with lower rates of long-term MI (OR: 2.74, CI 95%, 1.96–3.83, p < 0.0001) and long-term repeat revascularization (OR: 4.88, CI 95%, 1.99–11.91, p < 0.0001). The other secondary endpoints did not show any significant difference.

Conclusion: CABG appears superior to PCI over time in patients with CTO. This survival advantage may be associated with fewer events of MI and repeat revascularization.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024