Long-term outcomes of second-generation drug-eluting stents versus coronary artery bypass graft: a sistematic review and meta-analysis

ABSTRACT

INTRODUCTION: Long-term data is limited on the comparative outcomes of percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) versus coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD). Hypothesis: Our aim was to conduct a systematic review and meta-analysis comparing mortality and cardiovascular outcomes in patients with left main or multivessel CAD who underwent PCI with an S-DES versus CABG with a minimum mean follow-up period of 3 years. METHODS: We searched PubMed, Embase, and Cochrane for studies that examined our clinical question. Three reviewers independently performed study selection and data extraction. Statistical analysis was performed using Review Manager 5.4.1. We calculated pooled hazard ratios (HR) with 95% confidence intervals (CI) under a random effects model. The data from observational studies were extracted and pooled as multivariable-adjusted HR or propensity score matching to minimize confounding. RESULTS: We included 10 studies, 2 of which were randomized controlled trials (RCT), with a total of 25,866 patients, of whom 11,482 (44.3%) underwent PCI. The mean follow-up ranged from 3.0 to 11.8 years. S-DES had a significantly higher risk than CABG for all-cause mortality (HR 1.36; 95% CI 1.10-1.68; p=0.005) and myocardial infarction (MI) (HR 1.89; 95% CI 1.12-3.18; p=0.02). No significant difference between the groups was found for major cardiovascular events (HR 1.10; 95% CI 0.98-1.23; p=0.11) and stroke (HR 0.83; CI 0.60-1.15; p=0.27). In a subgroup analysis of RCTs, there was no significant difference between patients who underwent S-DES or CABG. CONCLUSION: In this meta-analysis of RCTs and multivariable or propensity-matched observational studies, our findings suggest that PCI with S-DES is associated with an increased risk of mortality and MI events compared with CABG in patients with left main or multivessel CAD.