A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome

• Published in: Scientific reports Vol. 12; no. 1; p. 5138
• Main Authors: Kirov, Hristo, Caldonazo, Tulio, Rahouma, Mohamed, Robinson, N. Bryce, Demetres, Michelle, Serruys, Patrick W., Biondi-Zoccai, Giuseppe, Gaudino, Mario, Doenst, Torsten
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 24-03-2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4019/2776; 692/4019/592; Acute coronary syndromes; Angioplasty; Bypass; Coronary artery; Coronary vessels; Heart attacks; Heart surgery; Humanities and Social Sciences; Meta-analysis; Mortality; multidisciplinary; Myocardial infarction; Observational studies; Patients; Science; Science (multidisciplinary)
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-09158-0

Non-ST-elevation acute coronary syndrome (NSTE-ACS) affects millions of patients. Although an invasive strategy can improve survival, the optimal treatment [i.e., percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] is not clear. We performed a meta-analysis of studies reporting outcomes between PCI and CABG in patients with NSTE-ACS. MEDLINE, EMBASE and Cochrane Library were assessed. The primary outcome was long-term mortality. Inverse variance method and random model were performed. We identified 13 observational studies (48,891 patients). No significant difference was found in the primary endpoint [CABG vs. PCI, incidence rate ratio (IRR) 0.93, 95% confidence interval (CI) 0.70; 1.23]. CABG was associated with lower long-term major adverse cardiovascular events (MACE) (IRR 0.64, 95% CI 0.54; 0.76) and lower long-term re-revascularization (IRR 0.37, 95% CI 0.30; 0.47). There was no significant difference in long-term myocardial infarction (CABG vs. PCI, IRR 0.96, 95% CI 0.50; 1.84) and peri-operative mortality (CABG vs. PCI, odds ratio 1.36, 95% CI 0.94; 1.95). For the treatment of NSTE-ACS, CABG and PCI are associated with similar rates of long-term mortality and myocardial infarction. CABG is associated with lower rates of long-term MACE and re-revascularization. Randomized comparisons in this setting are necessary.