Long-term outcomes of second-generation drug-eluting stents versus coronary artery bypass graft: A systematic review and meta-analysis of randomized trials and multivariable adjusted data

Authors

André Luiz Carvalho Ferreira, Department of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil.
Maria Esther Benitez Gonzalez, Advocate Health - MidwestFollow
Ana Emanuel Coelho Pessoa Lima, Department of Medicine, Bahiana School of Medicine and Public Health, Salvador.
Almir Alamino Lacalle, Division of Cardiology, University of Sao Paulo, Ribeirao Preto.
Gabriel Saad, Division of Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
Camila Mota Guida, Division of Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.

Recommended Citation

Carvalho Ferreira AL, Benitez Gonzalez ME, Coelho Pessoa Lima AE, Alamino Lacalle A, Saad G, Guida CM. Long-term outcomes of second-generation drug-eluting stents versus coronary artery bypass graft: a systematic review and meta-analysis of randomized trials and multivariable adjusted data. Coron Artery Dis. Published online January 21, 2025. doi:10.1097/MCA.0000000000001503

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Long-term data are limited comparing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) vs coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD). We aimed to conduct a systematic review and meta-analysis comparing these interventions in patients with left main or multivessel CAD. We systematically reviewed PubMed, Embase, and Cochrane for studies that compared PCI with S-DES and CABG in patients with left main or multivessel CAD with a minimum mean follow-up period of 3 years. Outcomes of interest were all-cause mortality, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). We extracted data from observational studies as multivariable-adjusted or propensity score-matched hazard ratio to minimize confounding and pooled hazard ratios with 95% confidence intervals (CIs) using a random effects model in Review Manager 5.4.1. We included 10 studies, 3 of which were randomized controlled trials, comprising a total of 26964 patients, of whom 14928 underwent PCI. As compared with CABG, S-DES had a significantly higher risk of all-cause mortality (hazard ratio 1.35; 95% CI 1.22-1.49; P < 0.001; I2 = 0%), MACE (hazard ratio 1.27; 95% CI 1.08-1.50; P = 0.005; I2 = 67%), and MI (hazard ratio 2.43; 95% CI 1.80-3.28; P < 0.01; I2 = 0%). There was no significant difference between groups in incidence of stroke. In this meta-analysis of patients with complex CAD, PCI with S-DES was associated with an increased risk of mortality, MI, and MACE compared with CABG.

Type

Article

PubMed ID

39831525