Coronary artery bypass surgery vs stenting for the treatment of multivessel disease: a meta-analysis of ARTS, SoS, ERACI-2 and MASS-2 - CABG vs stenting for the treatment of multivessel disease: a meta-analysis of ARTS, SoS, ERACI-2 and MASS-2

Description:

The goal of the meta-analysis was to evaluate coronary artery bypass surgery (CABG) vs stenting using individual patient data in patients with multivessel disease.

Study Design

Study Design:

Patients Enrolled: 3,051
Mean Follow Up: 1 year

Patient Populations:

Patients enrolled in the randomized trials ARTS, SoS, ERACI-2 and MASS-2, which were trials of CABG vs stenting in patients with multivessel disease.

Primary Endpoints:

Composite of death, myocardial infarction or stroke

Secondary Endpoints:

Mortality

Drug/Procedures Used:

Patients with multivessel disease were enrolled in the randomized trials ARTS, SoS, ERACI-2 and MASS-2. The trials randomized patients to CABG or stenting.

Principal Findings:

More than 50% of patients in the meta-analysis had two-vessel disease. Glycoprotein IIb/IIIa inhibitors were used in 7% of patients in the stent group. There was no difference in the primary endpoint of the composite of death, myocardial infarction or stroke (9.1% versus 8.7%). Mortality rates also did not differ between the bypass surgery and stent groups (2.8% versus 3.0%).

Interpretation:

Among patients with multivessel coronary artery disease, there was no statistical difference between treatment with bypass surgery versus stenting in the primary endpoint of death, MI or stroke at 1 year. The meta-analysis was conducting using trials that enrolled patients from 1995 to 2000 and used bare metal stents and primarily traditional on-pump bypass surgery. There have been several changes in practice in both groups, including drug-eluting stents and off-pump revascularization surgery. Two other trials comparing stenting with bypass surgery were not included in the meta-analysis. The AWESOME trial was excluded due to its inclusion of higher risk patients with medical refractory ischemia, and the SIAM trial was excluded due to the inclusion of patients with single vessel disease.

References:

Presented at the European Society of Cardiology, Vienna, Austria, September 2003.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease

Keywords: Coronary Artery Disease, Myocardial Infarction, Stroke, Metals, Drug-Eluting Stents, Coronary Artery Bypass, Stents


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