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Editor's Note |

Evolving Treatment Options in Coronary Artery Disease

Mitchell H. Katz, MD
JAMA Intern Med. 2014;174(2):231. doi:10.1001/jamainternmed.2013.7492.
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Coronary artery bypass grafting (CABG) is a major surgical procedure with substantial morbidity and mortality. It is therefore not surprising that percutaneous coronary interventions (PCIs), which are much less invasive, would seem like an attractive alternative.

However, this meta-analysis of 6 randomized studies comparing CABG with PCI in patients with multivessel disease shows the clear superiority of CABG: a 27% reduction in total mortality. The value of this meta-analysis is that it was powered for comparing mortality, which was not possible for the studies individually. There was also a significant reduction in myocardial infarction and in repeat revascularization with CABG. There was a trend toward more strokes with CABG, but it did not reach statistical significance, and the absolute rate of stroke was relatively low. The meta-analysis included only those studies performed in the modern era with a high use of arterial grafts for CABG and a high use of stents for PCI. Most patients had preserved ejection fraction.


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