Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery

  1. Dena M. Bravata, MD, MS;
  2. Allison L. Gienger, BA;
  3. Kathryn M. McDonald, MM;
  4. Vandana Sundaram, MPH;
  5. Marco V. Perez, MD;
  6. Robin Varghese, MD, MS;
  7. John R. Kapoor, MD, PhD;
  8. Reza Ardehali, MD, PhD;
  9. Douglas K. Owens, MD, MS; and
  10. Mark A. Hlatky, MD
  1. From the Center for Primary Care and Outcomes Research and Stanford University School of Medicine, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
    1. Appendix Figure.
      View larger version:
      Appendix Figure. Study flow diagram.

      CABG = coronary artery bypass grafting; CAD = coronary artery disease; PCI = percutaneous coronary intervention; RCT = randomized, controlled trial.

    2. Figure 1.
      View larger version:
      Figure 1. Procedural survival (top) and stroke risk (bottom).

      The size of each box is proportional to the sample size of the trial. Bars represent 95% CIs. The I2 statistic was <1 for both procedural survival and procedural stroke risk. AMIST = Angioplasty versus Minimally Invasive Surgery Trial; ARTS = Arterial Revascularization Therapies Study; AWESOME = Angina with Extremely Serious Operative Mortality Evaluation; BARI = Bypass Angioplasty Revascularization Investigation; CABG = coronary artery bypass grafting; CABRI = Coronary Angioplasty versus Bypass Revascularization Investigation; EAST = Emory Angioplasty versus Surgery Trial; ERACI = Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease; GABI = German Angioplasty Bypass Surgery Investigation; MASS = Medicine, Angioplasty, or Surgery Study; PCI = percutaneous coronary intervention; RITA = Randomized Intervention Treatment of Angina; SIMA = Stenting versus Internal Mammary Artery Study; SoS = Stent or Surgery. *Survival data were abstracted from Kaplan–Meier curves.

    3. Figure 2.
      View larger version:
      Figure 2. Five-year survival in patients with single-vessel disease (SVD) versus multivessel disease (MVD).

      The size of each box is proportional to the sample size of the trial. Bars represent 95% CIs. The I2 statistic for 5-year survival was 13 among SVD trials and 14 among MVD trials. ARTS = Arterial Revascularization Therapies Study; AWESOME = Angina with Extremely Serious Operative Mortality Evaluation; BARI = Bypass Angioplasty Revascularization Investigation; CABG = coronary artery bypass grafting; EAST = Emory Angioplasty versus Surgery Trial; ERACI = Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease; GABI = German Angioplasty Bypass Surgery Investigation; MASS = Medicine, Angioplasty, or Surgery Study; PCI = percutaneous coronary intervention; RITA = Randomized Intervention Treatment of Angina. *Data were abstracted from Kaplan–Meier curves.

    4. Figure 3.
      View larger version:
      Figure 3. Five-year survival with balloon angioplasty or stents versus coronary artery bypass grafting (CABG) in patients with multivessel disease (MVD).

      The size of each box is proportional to the sample size of the trial. Bars represent 95% CIs. The I2 statistic for 5-year survival was 10 among MVD trials using balloon angioplasty and <1.0 among trials using stents. ARTS = Arterial Revascularization Therapies Study; AWESOME = Angina with Extremely Serious Operative Mortality Evaluation; BARI = Bypass Angioplasty Revascularization Investigation; BMS = bare-metal stent; CABG = coronary artery bypass grafting; EAST = Emory Angioplasty versus Surgery Trial; ERACI = Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease; GABI = German Angioplasty Bypass Surgery Investigation; MASS = Medicine, Angioplasty, or Surgery Study; PCI = percutaneous coronary intervention; RITA = Randomized Intervention Treatment of Angina. *Survival data were abstracted from Kaplan–Meier curves.

    5. Figure 4.
      View larger version:
      Figure 4. Five-year survival in patients with diabetes.

      The size of each box is proportional to the sample size of the trial. Bars represent 95% CIs. The I2 statistic was 40. All studies that reported comparative effectiveness data for patients with diabetes were included in this analysis, not just studies that reported comparative outcomes for patients with and without diabetes. Hazard ratios from the German Angioplasty Bypass Surgery Investigation for death after PCI or CABG were reported to not differ between patients with or without diabetes; however, these data were not shown. AWESOME = Angina with Extremely Serious Operative Mortality Evaluation; BARI = Bypass Angioplasty Revascularization Investigation; CABG = coronary artery bypass grafting; EAST = Emory Angioplasty versus Surgery Trial; ERACI = Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease; MASS = Medicine, Angioplasty, or Surgery Study; PCI = percutaneous coronary intervention; RITA = Randomized Intervention Treatment of Angina.

    Responses to this article

    • Question of Data Exclusion
      • Daniel W Carlson
      Ann Intern Med published online October 26, 2009
    « Previous | Next Article »Table of Contents

    This Article

    1. Ann Intern Med November 20, 2007 vol. 147 no. 10 703-716
    1. AbstractFREE
    2. » Figures
    3. Full Text
    4. Full Text (PDF)
    5. CME Course
    6. Audio Summary

    Current Issue

    1. November 3, 2009, 151 (9)
    1. Alert me to current issues