CORONARY artery disease management shows comparable mortality outcomes between Coronary Artery Bypass Graft and Percutaneous Coronary Intervention, while Coronary Artery Bypass Graft demonstrates lower rates of adverse cardiovascular events and repeat revascularisation.
Coronary Artery Disease Treatment Outcomes
Current guidance has traditionally favoured Coronary Artery Bypass Graft for patients with multivessel and left main coronary artery disease due to improved long-term outcomes. However, emerging evidence has suggested comparable results between Coronary Artery Bypass Graft and Percutaneous Coronary Intervention in certain patient groups.
This systematic review and meta-analysis evaluated randomised controlled trials comparing both strategies, with a minimum follow up of 3 years. The primary endpoint was all cause mortality, with secondary endpoints including target vessel revascularisation and major adverse cardiovascular and cerebrovascular events.
Mortality And Risk Comparisons
Across included trials, no significant difference in all-cause mortality was observed between Coronary Artery Bypass Graft and Percutaneous Coronary Intervention in patients with either multivessel disease or left main coronary artery disease: relative risk: 0.90; 95% CI: 0.78–1.04. Subgroup analysis indicated a reduced risk of mortality with Coronary Artery Bypass Graft in patients with lower anatomical complexity, defined by a SYNTAX score below 23.
Despite similar mortality outcomes overall, Coronary Artery Bypass Graft was associated with a significantly lower risk of major adverse cardiovascular and cerebrovascular events: relative risk: 0.75; 95% CI: 0.70–0.81. In addition, the risk of target vessel revascularisation was reduced: relative risk: 0.50; 95% CI: 0.38–0.66. These benefits were consistent across subgroups irrespective of SYNTAX score.
Implications For Clinical Decision Making
The findings highlight that while mortality outcomes may not differ significantly, other clinically relevant endpoints favour Coronary Artery Bypass Graft. Reduced rates of repeat revascularisation and major adverse cardiovascular and cerebrovascular events may influence long term patient outcomes and healthcare utilisation.
These data emphasise the importance of individualised treatment discussions with patients, particularly with regard to balancing procedural risks, long term benefits, and anatomical complexity. Incorporating these findings into shared decision making may help optimise treatment selection for patients with complex coronary artery disease.
Reference
Saleem MM et al. Long-term clinical outcomes of CABG vs. PCI With DES for multivessel and left-main coronary artery disease: a systematic review and meta-analysis. Journal of Interventional Cardiology. 2026;6698370:14.
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