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Gaudino M, Audisio K, Hueb WA, Stone GW, Farkouh ME, Di Franco A, Rahouma M, Serruys PW, Bhatt DL, Biondi Zoccai G, Yusuf S, Girardi LN, Fremes SE, Ruel M, Redfors B. Coronary artery bypass grafting versus medical therapy in patients with stable coronary artery disease: An individual patient data pooled meta-analysis of randomized trials. J Thorac Cardiovasc Surg 2024; 167:1022-1032.e14. [PMID: 35821087 DOI: 10.1016/j.jtcvs.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES It is unclear whether coronary artery bypass grafting (CABG) improves survival compared with medical therapy (MT) in patients with stable coronary artery disease (CAD). The aim of this analysis was to perform an individual-patient data-pooled meta-analysis of contemporary randomized controlled trials that compared CABG and MT in patients with stable CAD. METHODS A systematic search was performed in January 2021 to identify randomized controlled trials enrolling adult patients with stable CAD, randomized to CABG or MT. Only trials using at least aspirin, beta-blockers, and statins in the MT arm were included. Individual patient data were obtained from all eligible studies and pooled. The primary outcome was all-cause mortality. RESULTS Four trials involving 2523 patients (1261 CABG; 1262 MT) were included with a median follow-up of 5.6 (4.0-9.2) years. CABG was associated with increased risk of all-cause mortality within 30 days (hazard ratio [HR], 4.81; 95% confidence interval [CI], 1.95-11.83) but subsequent reduction in the long-term risk of death (HR, 0.79; 95% CI, 0.69-0.89). As such, the cumulative 10-year mortality rate was lower in patients treated with CABG compared with MT (45.1% vs 51.7%, respectively; odds ratio, 0.70; 95% CI, 0.58-0.85). Age and race were significant treatment effect modifier (interaction P = .003 for both). CONCLUSIONS In patients with stable CAD, initial allocation to CABG was associated with greater periprocedural risk of death but improved long-term survival compared with MT. The survival advantage for CABG became significant after the fourth postoperative year and was particularly pronounced in younger and non-White patients.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
| | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Whady A Hueb
- Heart Institute of the University of São Paulo, São Paulo, Brazil
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Patrick W Serruys
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Mass
| | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY
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Sabik JF, Bakaeen FG, Ruel M, Moon MR, Malaisrie SC, Calhoon JH, Girardi LN, Guyton R. The American Association for Thoracic Surgery and The Society of Thoracic Surgeons Reasoning for Not Endorsing the 2021 ACC/AHA/SCAI Coronary Revascularization Guidelines. Ann Thorac Surg 2022; 113:1065-1068. [PMID: 34954249 DOI: 10.1016/j.athoracsur.2021.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc R Moon
- Washington University School of Medicine, St Louis, Missouri
| | | | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas
| | - Leonard N Girardi
- New York Presbyterian/Weil Cornell Medical Center, New York, New York
| | - Robert Guyton
- Cardiothoracic Surgery, Emory Clinic, Atlanta, Georgia
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Ruel M, Williams A, Ouzounian M, Sun L, Légaré JF, Poirier P, Malas T, Farkouh ME, Chedrawy E, Hassan A, Higgins J, Connelly K, McClure RS, Bewick D, Whitlock R, Graham M, Arora RC. Missing the Goal with the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. Can J Cardiol 2022; 38:705-708. [PMID: 35341903 DOI: 10.1016/j.cjca.2022.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/13/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON.
| | - Anne Williams
- Division of Cardiology, Department of Medicine, Memorial University, St. John's, NL
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, ON
| | - Louise Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, ON
| | | | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, QC
| | - Tarek Malas
- Département de Chirurgie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, QC
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, ON
| | - Edgar Chedrawy
- Division of Cardiac Surgery, QEII Health Sciences Centre, Halifax, NS
| | - Ansar Hassan
- Department of Cardiovascular Surgery, Maine Medical Center, Portland, Maine, USA
| | - Jennifer Higgins
- Division of Cardiac Surgery, St. Mary's General Hospital, Kitchener, ON
| | - Kim Connelly
- Keenan Research Centre for Biomedical Science, UnityHealth, University of Toronto, ON
| | - R Scott McClure
- Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, AB
| | - David Bewick
- Department of Medicine, New Brunswick Heart Center, Saint John, NB
| | | | - Michelle Graham
- Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB
| | - Rakesh C Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, MB
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4
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Sabik JF, Bakaeen FG, Ruel M, Moon MR, Malaisrie SC, Calhoon JH, Girardi LN, Guyton R. The American Association for Thoracic Surgery and The Society of Thoracic Surgeons reasoning for not endorsing the 2021 ACC/AHA/SCAI Coronary Revascularization Guidelines. J Thorac Cardiovasc Surg 2022; 163:1362-1365. [PMID: 35164950 DOI: 10.1016/j.jtcvs.2021.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc R Moon
- Washington University School of Medicine, St Louis, Mo
| | | | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Tex
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5
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Myocardial Revascularization Surgery: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2021; 78:365-383. [PMID: 34294272 DOI: 10.1016/j.jacc.2021.04.099] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/20/2022]
Abstract
Coronary artery bypass grafting (CABG) was introduced in the 1960s as the first procedure for direct coronary artery revascularization and rapidly became one of the most common surgical procedures worldwide, with an overall total of more than 20 million operations performed. CABG continues to be the most common cardiac surgical procedure performed and has been one of the most carefully studied therapies. Best CABG techniques, optimal bypass conduits, and appropriate patient selection have been rigorously tested in landmark clinical trials, some of which have resolved controversy and most of which have stoked further debate and trials. The evolution of CABG cannot be properly portrayed without presenting it in the context of the parallel development of percutaneous coronary intervention. In this Historical Perspective, we a provide a broad overview of the history of coronary revascularization with a focus on the foundations, evolution, best evidence, and future directions of CABG.
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Boyd JH. Commentary: Keep your friends close. J Thorac Cardiovasc Surg 2020; 162:100-101. [PMID: 33008576 DOI: 10.1016/j.jtcvs.2020.08.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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Grimm JC, Kilic A. Commentary: The ISCHEMIA trial: Throwing the baby out with the bathwater? J Thorac Cardiovasc Surg 2020; 162:101-102. [PMID: 32919776 DOI: 10.1016/j.jtcvs.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Joshua C Grimm
- Division of Cardiac Surgery, The University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Arman Kilic
- Division of Cardiac Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pa.
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