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El-Andari R, Bozso SJ, Fialka NM, Kang JJH, Hassanabad AF, Nagendran J. Alternative Approaches to Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention, How Do They Compare?: A Systematic Review and Meta-Analysis. Cardiol Rev 2024; 32:392-401. [PMID: 36688825 DOI: 10.1097/crd.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Coronary artery disease (CAD) is a leading cause of mortality worldwide. Severe symptomatic CAD is treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Alternative CABG (ACABG) approaches including thoracotomy, off-pump, total endoscopic, and robotic-assisted CABG are increasing in prevalence to address the increased early risk of CABG. This systematic review and meta-analysis aims to review the contemporary literature comparing outcomes after ACABG and PCI. Pubmed, Medline, and Embase were systematically searched by 2 authors for articles comparing the outcomes after ACABG and PCI. A total of 1154 articles were screened, and 11 were included in this review. The RevMan 5.4 software was used to perform a meta-analysis of the pooled data. Individual studies found rates of long-term survival, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction (MI), and repeat revascularization either favored ACABG or did not differ significantly. Pooled estimates of the compiled data identified rates of MACCE, MI, and repeat revascularization favored ACABG. The results of this review demonstrated the favorable rates of long-term mortality, MACCE, MI, and repeat revascularization for ACABG in addition to similar short-term mortality and stroke when compared with PCI. Advancement of both CABG and PCI continues to improve patient outcomes. With the increasing prevalence of ACABG, similar studies will need to be undertaken with further direct comparisons between ACABG and PCI. Finally, hybrid revascularization should continue to be explored for its combined benefits of long-term outcomes, short-term safety, and ability to achieve complete revascularization.
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Affiliation(s)
- Ryaan El-Andari
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Sabin J Bozso
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jimmy J H Kang
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Jeevan Nagendran
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Nishigawa K, Fukui T, Hagiya K, Tobaru T, Uemura K, Takanashi S. Propensity score-matched analysis of coronary artery bypass grafting versus second-generation drug-eluting stents for triple-vessel disease. Eur J Cardiothorac Surg 2019; 55:1152-1159. [PMID: 30561571 DOI: 10.1093/ejcts/ezy415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/05/2018] [Accepted: 11/03/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to compare the mid-term results of coronary artery bypass grafting (CABG) with those of percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DESs) for triple-vessel disease. METHODS Between February 2010 and December 2015, 607 patients underwent primary isolated CABG and 264 patients underwent PCI with second-generation DESs (everolimus-eluting stent, biolimus-eluting stent or zotarolimus-eluting stent) for triple-vessel disease with or without left main disease. We compared the CABG group with the second-generation DES group using propensity score matching analysis. The study end points were major adverse cardiac and cerebrovascular events. RESULTS After propensity score matching, 238 pairs of patients were successfully matched (C-statistic 0.762). The mean number of distal anastomoses in the CABG group was 4.7 and that of implanted stents in the second-generation DES group was 2.8. The 30-day mortality was similar between the groups (0.8% vs 0.4%; P = 0.564). The median follow-up period was 3.4 years in the CABG group and 3.8 years in the second-generation DES group. Although there was no significant difference in the incidence of all-cause death and cerebrovascular accidents, the incidence of myocardial infarction [hazard ratio (HR) 11.76; 95% confidence interval (CI) 2.32-214.15, P = 0.003] and repeat revascularization (HR 3.78; 95% CI 2.35-6.38; P < 0.001) was significantly higher in the second-generation DES group than in the CABG group. This resulted in a higher incidence of major adverse cardiac and cerebrovascular events (HR 2.27; 95% CI 1.61-3.24; P < 0.001). CONCLUSIONS CABG might be superior to PCI with second-generation DESs for treatment of triple-vessel disease in terms of major adverse cardiac and cerebrovascular events.
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Affiliation(s)
- Kosaku Nishigawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kohei Uemura
- Biostatistics and Bioinformatics Course, The University of Tokyo, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
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Kim JH, Lee SH, Joo HC, Yoo KJ, Youn YN. Repeated Target Vessel Revascularization After Coronary Artery Bypass for In-Stent Restenosis. Ann Thorac Surg 2017; 104:1332-1339. [PMID: 28377035 DOI: 10.1016/j.athoracsur.2017.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/18/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The purpose of this study was to examine the impact of previous percutaneous coronary intervention with stent on long-term outcomes after off-pump coronary artery bypass grafting (OPCAB). METHODS Between January 2001 and December 2014, 1,668 patients with triple-vessel disease undergoing OPCAB were reviewed and divided into 2 groups. The no-stent group (n = 1,409) included patients who underwent OPCAB as a primary revascularization procedure and the stent group (n = 259) included patients with a history of percutaneous coronary intervention with stent. The mean follow-up duration was 5.32 ± 3.39 years. RESULTS After propensity score matching, characteristics of both groups were comparable (n = 259 in each group). In-hospital mortality (n = 3 [1.2%] in both groups; p > 0.999) was similar. The 14-year overall survival rate (75.6% ± 6.6% in the no-stent group versus 71.9% ± 8.5% in the stent group; p = 0.917) and freedom from major adverse cardiac and cerebrovascular events (MACCEs) rate (68.3% ± 6.6% versus 54.6% ± 8.5%; p = 0.239) were also similar. However, freedom from target vessel revascularization (TVR) rate at 14 years was significantly higher in the no-stent group (97.2% ± 1.7% versus 76.9% ± 6.5%; p < 0.001). The independent risk factor for late TVR was in-stent restenosis (hazard ratio, 3.355; 95% confidence interval, 1.925 to 5.848; p < 0.001) and it also was a risk factor for MACCEs (hazard ratio, 1.645; 95% CI, 1.105 to 2.448; p = 0.014). CONCLUSIONS Previous intracoronary stenting does not increase long-term mortality, but grafting to previously stented target vessels with in-stent restenosis increases the risk of repeat TVR and MACCEs.
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Affiliation(s)
- Jung-Hwan Kim
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Korea
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Korea
| | - Hyun-Chel Joo
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Korea
| | - Kyung-Jong Yoo
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Korea.
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Guo L, Ding Y, Liu F, Zhu W, Jiang X. Role of Second-Generation Drug-Eluting Stents and Bypass Grafting in Coronary Artery Disease: A Systematic Review and Meta-analysis. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Yanagawa B, Puskas JD. State-of-the-art surgical coronary revascularization: Multiple arterial conduits, minimal aortic manipulation. J Thorac Cardiovasc Surg 2015; 150:259-61. [DOI: 10.1016/j.jtcvs.2015.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 02/23/2015] [Indexed: 11/16/2022]
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Surgical versus percutaneous revascularization in patients with multivessel coronary artery disease. Curr Atheroscler Rep 2014; 16:461. [PMID: 25344743 DOI: 10.1007/s11883-014-0461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
New-generation stents have been continually developed in order to improve the safety and efficacy of percutaneous coronary intervention (PCI). Several randomized clinical trials have been conducted over the last two decades to compare the outcomes of PCI with coronary artery bypass grafting (CABG), which has been the time-tested treatment of multivessel coronary artery disease. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial is one of the most recent and largest randomized controlled trials comparing PCI using the paclitaxel-eluting first-generation stent with CABG and was uniquely formulated to represent "real world" daily practice. The final 5-year main results of this trial and its various prespecified subgroups have been published in the past year. These results will form the basis of the new guidelines that will be published in the near future. This review is a compilation of the results of the SYNTAX trial and comparisons with other contemporary trials, meta-analyses, and retrospective studies of large registries and how these results help cardiac surgeons and cardiologists in judicious decision-making for their patients with multivessel coronary artery disease requiring revascularization.
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Zhuang X, Wang W, Lu D. Response to the comment letter about adjustment. Int J Cardiol 2014; 176:1365-6. [PMID: 25127962 DOI: 10.1016/j.ijcard.2014.07.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Xianmian Zhuang
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wujun Wang
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Di Lu
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
| | - Takuya Umemoto
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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Lu D, Nie X, Wan J, He S, Du S, Zhang Z, Wang Z, Wang W. Is off-pump coronary artery bypass grafting superior to drug-eluting stents for the treatment of coronary artery disease? A meta-analysis of randomized and nonrandomized studies. Int J Cardiol 2014; 174:640-53. [PMID: 24814900 DOI: 10.1016/j.ijcard.2014.04.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/15/2014] [Accepted: 04/17/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND As drug-eluting stent (DES) has almost overcome the disadvantage of frequent restenosis, off-pump coronary artery bypass grafting (OPCAB) has been introduced to avoid complications of cardiopulmonary bypass. However, which approach may promise better outcomes for patients with coronary artery disease remains controversial. METHODS Three databases were searched. The outcomes of interest were major adverse cardiac and cerebrovascular events (MACCE), all-cause death, target vessel revascularization (TVR), repeat revascularization (RRV), myocardial infarction (MI), and cerebrovascular events (CVE). The relative risk (RR) was calculated as the summary statistic. RESULTS 11,452 patients from 22 studies were included, of which 4949 patients underwent OPCAB and 6503 patients received DES. The cumulative rates of MACCE (RR [95% CI]=0.43 [0.34, 0.54], P<0.00001), all-cause death (RR [95% CI]=0.56 [0.33, 0.96], P=0.03), TVR (RR [95% CI]=0.33 [0.21, 0.53], P<0.00001), RRV (RR [95% CI]=0.22 [0.11, 0.42], P<0.00001) and MI (RR [95% CI]=0.13 [0.05, 0.29], P<0.00001) at 3 years were all lower in OPCAB group. The incidences of in-hospital death (RR [95% CI]=1.31 [0.81, 2.13], P=0.27) and MI (RR [95% CI]=1.03 [0.60, 1.78], P=0.92) were not different between groups, but the rate of in-hospital CVE was lower (RR [95% CI]=2.6355 [1.0033, 6.9228], P=0.05) in DES group. CONCLUSIONS OPCAB presents better long-term outcomes of MACCE, all-cause mortality, TVR, RRV and MI but uncertain outcome of postoperative CVE without influencing the incidences of in-hospital death and MI.
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Affiliation(s)
- Di Lu
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Ximing Nie
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jun Wan
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Shengping He
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Songlin Du
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zhen Zhang
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zhenkang Wang
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wujun Wang
- Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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Takagi H, Watanabe T, Mizuno Y, Kawai N, Umemoto T. A review with meta-analysis of observational studies for survival following off-pump coronary artery bypass versus drug-eluting stent implantation. Interact Cardiovasc Thorac Surg 2014; 18:807-13. [PMID: 24591399 DOI: 10.1093/icvts/ivu024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To determine whether off-pump coronary artery bypass (OPCAB) improves survival over drug-eluting stent (DES) implantation, we performed a review with meta-analysis of exclusive OPCAB versus DES. Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through October 2013 using Web-based search engines (PubMed and OVID). Studies that met the following criteria were considered for inclusion: the design was a randomized controlled trial or observational comparative study; the study population was patients with any coronary artery disease; patients were assigned to OPCAB versus DES and outcomes included all-cause mortality at ≥1 years. Our exhaustive search identified no randomized trial and 10 observational studies of OPCAB versus DES. A pooled analysis demonstrated no statistically significant difference in all-cause mortality between OPCAB and DES (hazard ratio, 0.94; 95% confidence interval, 0.76-1.15; P = 0.55). In general, exclusion of any single study from the analysis did not substantially alter the overall result of our analysis. There was no evidence of significant publication bias. In conclusion, OPCAB may not improve survival over DES despite greater number of treated vessels in OPCAB than in DES or greater number of distal anastomosis in OPCAB than that of implanted stents in DES.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Taku Watanabe
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Yusuke Mizuno
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Norikazu Kawai
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Takuya Umemoto
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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Abstract
Patients with major or symptomatic coronary artery disease (CAD) commonly undergo revascularization--either with CABG surgery, which has been the mainstay of revascularization for more than half a century, or with percutaneous coronary intervention (PCI), which has become the more-commonly used strategy in the past decade. PCI has been tested in more randomized clinical trials than any other procedure in contemporary practice. In general, PCI is the preferred option for treating patients with simple coronary artery lesions and CABG surgery remains the standard of care for patients with complex CAD. Technical advancements in PCI and CABG surgery make comparisons of historical data for these strategies difficult. In this Review, we evaluate the evidence-based use of PCI and CABG surgery in treating patients with multivessel and unprotected left main stem disease and for specific patient groups, including those with diabetes mellitus, chronic heart failure, or chronic kidney disease. Finally, we highlight the available tools to aid decision-making, including clinical guidelines, risk scoring systems, and the role of the 'heart team'.
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Kolh P. Invited commentary. Ann Thorac Surg 2013; 96:542. [PMID: 23910103 DOI: 10.1016/j.athoracsur.2013.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 05/10/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Philippe Kolh
- CT Surgery, University Hospital of Liege, CHU Sart Tilman B35, Liege 4000, Belgium.
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