Table 1.

Outcomes of CABG Versus PCI for Coronary Revascularization.

Year Study Result Notes
2009 SYNTAX62 Lower MACCE with CABG rates in patients with severe coronary disease as defined by SYNTAX score Supports CABG as the standard of care for patients with 3-vessel disease or complex left main CAD
2011 PRECOMBAT63 PCI with sirolimus-eluting stents was non-inferior to CABG in patients with unprotected left main CAD with respect to MACCE at 1 year Both groups had similar rates of death/MI/stroke. Occurrence of ischemia-driven, target-vessel revascularization at 2 years was lower in CABG than PCI
2011 STITCH64 Compared conservative treatment with medical therapy vs. medical therapy + CABG in patients with CAD and LV dysfunction. No significant differences in all-cause mortality, though rate of cardiac-cause hospitalization was lower with CABG 10-year follow-up, reported in 2019, concluded that CABG reduces all-cause mortality, and cardiovascular and heart failure hospitalizations71
2012 ASCERT65 No significant difference in mortality between patients ≥65 years with 2- or 3-vessel disease undergoing CABG vs. PCI at 1 year. Lower mortality with CABG than PCI at 4-year follow-up
2012 FREEDOM66 CABG superior to PCI in patients with diabetes and multivessel disease; signifi-cantly reduced death and MI at 5 years Some increased risk of strokes in the CABG group
2015 BEST67 For multivessel CAD patients, higher MACE in PCI vs. CABG group; higher spontaneous MI and repeat revasculariza-tion after PCI vs. CABG Similar comparison to FREEDOM trial
2019 EXCEL68 At 5 years, no significant difference in death/stroke/MI between PCI and CABG patients with left main CAD of low or intermediate anatomical complexity Some methodological controversy:72 incidence of all-cause mortality significantly higher in PCI group at 5 years, but all-cause mortality classified as a secondary not primary endpoint. Repeat revascu-larization was significantly higher in PCI vs. CABG groups (also not a primary endpoint). Occurrence of composite death, stroke, MI score shifted from favoring PCI to favoring CABG after 30-days’ follow-up, which may indicate CABG is preferred in patients with a higher life expectancy
2020 NOBLE69 PCI had inferior 5-year clinical outcomes in patients with left main disease as compared with CABG Both procedures had similar rates of mortality, but PCI had higher rates of repeat revascularization and of non-procedural MI
2022 FAME III70 Examined whether FFR-guided PCI was non-inferior to CABG in 1-year composite outcome (death, MI, stroke, or repeat revascularization) in patients with 3-vessel disease. The study did not show non-inferiority, and CABG resulted in lower incidence of composite outcome 30-day CABG mortality was 0.3%, identical to that of PCI
2023 Meta-analysis of Randomized Trials73 During 5-year follow-up, PCI showed higher incidence of all-cause mortality, MI, and repeat coronary revascularization Meta-analysis comparing CABG and PCI for treatment of left main or multivessel disease
Elevated risk of stroke in 30-day post-operative period for CABG, but no long-term difference at 5-year follow-up

CABG, coronary artery bypass graft; CAD, coronary artery disease; FFR, fractional flow reserve; LV, left ventricle/ventricular; MACCE, major adverse cardiovascular and cerebrovascular events; MACE, major adverse cardiovascular events; MI, myocardial infarction; PCI, percutaneous coronary intervention.

RMMJ Rambam Maimonides Medical Journal Rambam Health Care Campus 2024 January; 15(1): e0001. ISSN: 2076-9172
Published online 2024 January 19. doi: 10.5041/RMMJ.10515.