Determinants of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis
Dr. Premjithlal Bhaskaran,
Department of Cardiothoracic Surgery, Imperial College, London, United Kingdom.
Introduction: Coronary Artery Bypass Graft (CABG) surgery has potential benefits for patients with Coronary Artery Disease (CAD). The consensus associated with Percutaneous Coronary Intervention (PCI) and CABG was in terms of clinical outcomes, type of vessel disease, repeat revascularization, stroke, myocardial infarction, and heart failure. Hence, a comparison of PCI versus CABG is becoming important to identify patients who would benefit from PCI and CABG.
Aim: This review was conducted to identify the pathophysiological determinants of PCI and CABG.
Materials and Methods: In the present systematic review, Medline (PubMed), EMBASE, ProQuest, and the Cochrane database were searched, by using the key words “PCI” OR “percutaneous coronary intervention” AND “CABG” OR “coronary artery bypass grafting”. The searches were restricted from January 2009 to June 2021, with studies published in the English language. Comparative studies of CABG versus PCI with stent placement were the inclusion criteria. For meta-analysis Mantel–Haenszel Odds Ratio (MHOR) with its 95% Confidence Interval (CI), Mean Difference (MD) with its 95 % CI were computed.
Results: Overall, 408 titles or abstracts were identified from the initial search, of which full manuscripts of 93 studies were retrieved, in the first phase. Later, 71 studies were excluded. Of the remaining 22 studies, 19 were subjected to meta-analysis. This review contributes a sample size of 17,053. Mean age of the study population of PCI group was 66.15±10.71 years and in CABG group it was 66.16±9.43 years. PCI was performed among patients with higher ejection fraction (MD=2.13; 95% CI=1.75 to 2.52) or higher Synergy between percutaneous coronary intervention with Taxus and coronary artery bypass surgery (SYNTAX) score score (MD=-3.43; 95% CI=-3.98 to -2.87). CABG was considered for the patients with a higher Euro score (MD=0.28; 95% CI=0.2 to 0.35).
Conclusion: The ejection fraction, SYNTAX score, euro score, type of vessel disease, chronic kidney disease, and diabetes are the determinants of PCI and CABG.