Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 36845

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : PE01 - PE05 Full Version

Determinants of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis

Published: May 1, 2022 | DOI:
Premjithlal Bhaskaran, TS Sanal, India Premjithlal Bhaskaran, Nikolaos Anastasiou

1. Department of Cardiothoracic Surgery, Imperial College, London, United Kingdom. 2. Department of Biostatistics, Jothydev’s Diabetes Hospital and Research Centre, Trivandrum, Kerala, India. 3. Department of Cardiovascular Surgery, Imperial College, London, United Kingdom. 4. Department of Thoracic Surgery, General Oncology Hospital, Agioi Anaragyroi, Athens, Greece.

Correspondence Address :
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.


Coronary artery disease, Ejection fraction, Euro score, Revascularisation

Percutaneous coronary intervention is focused on treating flow disrupting lesions and it is constrained to new infarcts. The CABG supports the flow distal to the occluded vessel. The CABG was primarily done in patients with triple vessel disease and PCI was performed in single or double vessel diseased cases (1).

Even though PCI is routinely followed, the CABG is considered as gold standard for cardiac remodeling. The consensus associated with PCI and CABG was in terms of safety outcomes, especially an increase in repeat revascularization in PCI and an increase in the incidents of strokes among CABG cases. However, CABG is the best revascularization technique, conferring decreased mortality and risk of repeat revascularization (2). PCI is suggested to be an appropriate revascularization procedure in patients with a lower SYNTAX score and CABG is preferred for the cases with a high euro score (3). Non-surgical patients present a challenge in the treatment and are recommended for the PCI with bare metal stents. Unfortunately, the mortality and revascularization rates are inferior among PCI cases, when compare with CABG (4).

CABG is not a cure for Coronary Heart Disease (CHD), as it does not stop disease progression and the grafts can calcify with restenosis. It also carries the risks of Myocardial Infarctions (MI), stroke, arrhythmias and death. PCI has advanced the survival of patients with CHD by reducing the need for CABG. Independent of stent type used, the PCI reports patient survival as well as the incidence of MI (2). Despite the development in stent technology, pharmacotherapy or adjunctive imaging, which made the use of PCI a common treatment regimen, CABG continues to be the standard treatment for CAD. However, the optimal revascularization procedure in CAD patient’s remains controversial (5). The emergence of drug eluting stents and advancement in technology has caused a pivotal role in cardiology (6). Hence, identifications of patients who would benefit from PCI and CABG would be intriguing. This review aimed to identify the pathophysiological determinants of PCI and CABG.

Material and Methods

In the present systematic review, Medline (PubMed), EMBASE, ProQuest, and the Cochrane database were searched, by utilizing a combination of the relevant Medical Subject Heading (MeSH) terms and the key words “PCI” OR “percutaneous coronary intervention” AND “CABG” OR “coronary artery bypass grafting”. In the Cochrane database the search was limited by the term “clinical trial”. The searches were restricted from January 2009 to June 2021 with studies published in the English language. Citations were screened at the title or abstract level and retrieved as a full report if they were clinical studies, compared PCI with CABG.The literature search and analysis was conducted from December 2020 to June 2021.

Inclusion criteria: Randomized Controlled Trials (RCTs), cohort and descriptive studies, which made an attempt to address the pathophysiological characteristics of revascularization procedures, were included. The studies conducted on adult patients who underwent PCI or CABG irrespective of study setting and regions were also included.

Exclusion criteria: If the outcome measure (pathophysiological determinants) was not reported or was impossible to extract or calculate from the available results, then such studies were excluded.

Study Procedure

Search strategy: Screening criteria in preliminary search were the pathophysiological determinants associated with PCI and CABG. In the second phase full manuscripts of all the studies which qualified the screening criteria, were obtained. Selection criteria were applied to each of these studies and valid studies were subjected for final data extraction.

Methods used to collect the data: The keywords “PCI” OR “percutaneous coronary intervention” AND “CABG” OR “coronary artery bypass grafting” were entered into different database and year wise search was conducted. Titles or abstracts were screened for the content and full manuscripts of the studies were obtained. All the downloaded articles were studied and subjected for eligibility criteria and a list of selected studies was obtained. They were further subjected for inclusion and relevant data were extracted.

Quality assessment: All the included studies for meta-analysis were subjected to methodological quality appraisal using the Cochrane risk of bias assessment tool, and the Joanna Briggs Institute (JBI) checklist for descriptive and cohort studies (7), (8). For each item the response was recorded as yes or no and a credit point of “one” was assigned for yes and “zero” for no. Total counts of all the points were obtained. Higher counts indicates well appraisal.

Statistical Analysis

For meta-analysis MHOR, MD, and 95% CI were computed by using the fixed effect model. The Chi- square and I2 statistic were used to test heterogeneity (9).The Review Manager Software (Rev Man 5, Cochrane collaboration, Oxford, England) was used for data analytics (10).


Overall, 408 citations were identified from the initial search, of which 93 studies were retrieved. Later, 315 studies were excluded. Of the remaining 22 studies, 19 were subjected to meta-analysis in the second phase (Table/Fig 1). The critical appraisal of the studies included in the present review has been shown in (Table/Fig 2) (11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30),(31),(32).

The studies selected for meta-analysis (n=19) contributed a sample of size 17,053 (Table/Fig 1). A total of 9,663 (57%) patients underwent PCI and 7,390 (43%) underwent CABG. Mean age of the study population in PCI group was 66.15±10.71 and in CABG group it was 66.16±9.43.Thus age was homogeneous (MD=0.14; 95% CI=-0.15 to 0.43) between PCI and CABG (Table/Fig 3).

The majority of the study population was males (71% in the PCI group and 73% in CABG). Performance of PCI or CABG was not associated (MHOR=0.97; 95% CI=0.91 to 1.04) with gender (Table/Fig 4).

The PCI was extensively performed in single vessel disease cases (MHOR=3.09; 95% CI=2.6 to 3.68) or double vessel disease cases (MHOR=2.52; 95% CI=2.25 to 2.81) (Table/Fig 5),(Table/Fig 6). The patients with triple vessel disease underwent CABG (MHOR=0.24; 95% CI=0.21 to 0.26) (Table/Fig 7).

Choices for PCI and CABG was not associated with peripheral vascular diseases (MHOR=0.99; 95% CI=0.82 to 1.19), cardiovascular diseases (MHOR=0.92; 95% CI=0.56 to 1.52), previous MI (MHOR=1.1; 95% CI=1 to 1.21), previous heart failure (MHOR=0.91; 95% CI=0.78 to 1.05), Hyperlipidemia (MHOR=1; 95% CI=0.88 to 1.14) smoking habit (MHOR=0.89; 95% CI=0.83 to 0.95), hypertension (MHOR=0.93; 95% CI=0.87 to 1) and stroke (MHOR=1.04;95% CI=0.91 to 1.19) (Table/Fig 8),(Table/Fig 9),(Table/Fig 10),(Table/Fig 11),(Table/Fig 12),(Table/Fig 13),(Table/Fig 14),(Table/Fig 15).


The PCI and CABG improve prognosis in CAD patients by attenuating the ischemic state and reversing the left ventricular remodeling (33). Effectiveness of PCI and CABG is associated with revascularization and clinical outcomes. Cases with an EF of 35% or less have reported better survival with CABG than PCI (34).Those patients who undergo PCI multiple times before being referred for CABG were at higher risk for graft failure (33).

CABG has been found to be superior to PCI in patients older than seventy years with respect to the incidence of adverse cardiac events. Among the patients younger than seventy years, there was no difference in the adverse cardiac events between PCI and CABG (35). In this study, there was no difference in age between PCI and CABG groups. Also, the performance of PCI and CABG was not associated with gender. However, despite the similar prevalence of CAD between the genders, female cases were less likely to undergo revascularization (36).

PCI is associated with single or double vessel diseases and it is mainly driven by higher rates of myocardial infarction and revascularization. CABG is associated with multi-vessel or unprotected left main coronary artery disease (15). The lower rate of adverse cardiac or cerebrovascular events at one year among patients with triple vessel diseases or left main CAD (or both) induces CABG as standard care as compared with PCI (37). CABG improves Left Ventricular (LV) function and it reverses adverse remodeling. This has resulted in improved survival rate and decreased the incidence of adverse cardiac events. However, CABG in patients without viable myocardium (hibernating / stunned myocardium)leads to an unfavorable structural alteration and the clinical benefits (38). The magnitude of the recovered ventricular function was reported to be proportional to the amount of dysfunctional myocardium, greater than 25% LV (four from seventeen segment model) results in improvement in reverse remodeling (38). The rate of peripheral vascular diseases, previous MI, heart failure, stroke, diabetes, hyperlipidemia, smoking habit and hypertension are consistently homogeneous between PCI and CABG.

Patients with previous CABG often develop progression of atherosclerotic diseases and hence they may require further revascularization. Among such cases, PCI is associated with higher incidence of restenosis, procedural complications and chronic adverse cardiac events (32). However, PCI with drug eluting stents for ostial or mid-shaft lesions in CAD demonstrated favorable clinical outcomes than PCI for distal bifurcation lesions (31). The ability of drug eluting stents to reduce restenosis as compared to PCI with bare metal stents enhances their use in CAD. Thus, in left main stenosis has become an alternative to surgery and it favors for further revascularization (30).

Patients with a high SYNTAX score undergo CABG and cases with a high euro score followed PCI. Performance of PCI is also associated with a higher ejection fraction (3). PCI with stent implantation and CABG are associated with Q-wave MI, cerebrovascular accidents, angina, or stroke among CAD patients (12),(15). The Target Vessel Revascularization (TVR) rates were reportedly higher among PCI group than CABG. This inferiority character of TVR was associated with repeat revascularization, whereas the risk of MI was non inferior in PCI cases with lower perioperative morbidity (31). In PCI group, the rate of long-term repeat revascularization was higher than CABG. The decision towards PCI and CABG also determined by the anticipated periprocedural risk, graft occlusion and restenosis; based on the SYNTAX score, lesions observed in morphology, and underlying co-morbidities (23), (27)


Stratification of patients into PCI and CABG was reported among the included studies have been followed by the eligibility criteria of this review. However, the PCI procedures can be altered with respect to number of stents implanted, repeated revascularization, and types of techniques (culotte / V-stenting / protrusion / crush) used. These heterogeneities were the major limitations of this study.


The PCI is thought to be limited mainly to single vessel disease whereas CABG provided better outcomes in complex multi vessel diseased cases. The ejection fraction, SYNTAX score, euro score, type of vessel disease, CKD, and presence of diabetes are the pathophysiological determinants for PCI and CABG.


Spadaccio C, Benedetto U. Coronary artery bypass grafting (CABG) vs. percutaneouscoronary intervention (PCI) in the treatment of multivesselcoronary disease: quo vadis? A review of the evidences oncoronary artery disease. Ann Cardiothorac Surg. 2018; 7(4):506-15. [crossref] [PubMed]
Doenst T, Haverich A, Serruys P, Bonow RO, Kappetein P, Falk V, et al. PCI and CABG for treating stable coronary artery disease: JACC review topic of the week. JACC. 2019; 73(8):964-76. [crossref] [PubMed]
Bundhun PK, Yanamala CM, Huang F. Percutaneous coronary intervention, coronary artery bypass surgery and the SYNTAXscore: A systematic review andmeta-analysis.Sci Rep. 2017;7: 43801-11. [crossref] [PubMed]
Rai P, Taylor R, Bittar MN. Long-term survival in patients who hadCABG with or without prior coronaryartery stenting. Open Heart. 2020; 7:001160.
Qiu M, Ding L, Zhan Z, Zhou H. Impact of time factor and patient characteristics on the efficacy of PCI vs CABG for left main coronary disease: A meta-analysis. Medicine (Baltimore). 2021; 100(10):e25057. [crossref] [PubMed]
Qian C, Feng H, Cao J, Wei B, Wang Y. Meta-analysis of randomized control trials comparing drug-eluting stents versus coronary artery bypass grafting for significant left main coronary narrowing. Am J Cardiol. 2017; 119:1338-43. [crossref] [PubMed]
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions version 6.1 (updated September 2020). Cochrane, 2020. [crossref]
Joanna Briggs Institute Critical appraisal tools for use JBI systematic reviewers. Joanna Briggs Institute. 2017. The University of Adelaide South Australia 5005. Accessed date: 8/2/2021.
Julian PT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in Meta analysis. BMJ.2003; 327: 557-60. [crossref] [PubMed]
RevMan 5 download RevMan web page. Accessed date: 20/12/2020.
Boudriot E, Thiele H, Walther T, Liebetrau C, Boeckstegers P, Pohl T, et al. Randomized comparison of percutaneous coronary intervention with sirolimuseluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J Am Coll Cardiol. 2011; 57: 538-45. [crossref] [PubMed]
Cavalcante R, Sotomi Y, Lee CW, Ahn JM, Farooq V, Tateishi H, et al. Outcomes after percutaneous coronary intervention or bypass surgery in patients with unprotected left main disease. J Am Coll Cardiol. 2016; 68:999-1009. [crossref] [PubMed]
Cheng CI, Lee FY, Chang JP, Hsueh SK, Hsieh YK, Fang CY, et al. Long-term outcomes of intervention for unprotected left main coronary artery stenosis: coronary stenting vs coronary artery bypass grafting. Circ J. 2009; 73:705-12. [crossref] [PubMed]
Chieffo A, Meliga E, Latib A, Park SJ, Onuma Y, Capranzano P, et al. Drug-eluting stent for left main coronary artery disease. The DELTA registry: A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. JACC Cardiovasc Interv. 2012; 5:7 18-27.
Eeunlee S, Young LH, Cho HJ, Seok CW, Kim H, Choi JO, et al. Coronary artery bypass graft versus percutaneous coronary intervention in acute heart failure. Heart.2018; 106:50-57. [crossref] [PubMed]
Ghenim R, Roncalli J, Tidjane AM, Bongard V, Ziani A, Boudou N, et al. One-year follow-up of nonrandomized comparison between coronary artery bypass grafting surgery and drug-eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (aged .75 years). J Interv Cardiol. 2009; 22: 520-26. [crossref] [PubMed]
Kang SH, Lee CW, Yun SC, Lee PH, Ahn JM, Park DW, et al. Coronary artery bypass grafting versus drug-eluting stent implantation for left main coronary artery disease (from a two-center registry). Am J Cardiol. 2010; 105:343-51. [crossref] [PubMed]
Kurlansky P, Herbert M, Prince S, Mack M. Coronary artery bypass graft versus percutaneous coronary intervention meds matter: impact of adherence to medical therapy on comparative outcomes. Circulation.2016; 134:1238-46. [crossref] [PubMed]
Minlu T, Lee WL, Hsu PF, Lin TC, Sung SH, Wang KL, et al. Long-term results of stenting versus coronary artery bypass surgery for left main coronary artery disease A single-center experience. J Chin Med Ass. 2016; 356-62. [crossref] [PubMed]
Papadopoulos K, Lekakis I, Nicolaides E.Outcomes of coronary artery bypass graftingversus percutaneous coronary interventionwith second-generation drugelutingstents for patients with multi vessel andunprotected left main coronary arterydisease. SAGE Open Medicine. 2017; 5:1-5. [crossref] [PubMed]
Park DW, Kim YH, Yun SC, Lee JY, Kim WJ, Kang SJ, et al. Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MA IN (ASAN Medical Center-Left MAIN Revascularization) Registry. J Am Coll Cardiol. 2010; 56: 136 6–75.
Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, Song HG, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med.2011; 364: 1718–27 [crossref] [PubMed]
Pengyu T, Yanwu C, Ren XJ, Yuan F, Song XT, Luo Y, et al. very long-term outcomes and predictors of percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting for patients with unprotected left main coronary artery disease. Chin Med J. 2016; 129:763-70. [crossref] [PubMed]
Qin Q, Qian J, Wu X, Fan B, Ge L, Ge J, et al. A comparison between coronary artery bypass grafting surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease. Clin Cardiol. 2013; 36: 54–60. [crossref] [PubMed]
Shimizu T, Ohno T, Ando J, Fujita H, Nagai R, Motomura N, et al. Mid-term results and costs of coronary artery bypass vs drug-eluting stents for unprotected left main coronary artery disease. Circ J. 2010; 74: 449–55. [crossref] [PubMed]
Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Sakata R. Comparison of percutaneous coronary intervention with coronary artery bypass grafting in unprotected left main coronary artery disease 5-year outcome from CREDOK yoto PCI/CAB G Registry Cohort-2. Circ J. 2015; 79: 1282–89. [crossref] [PubMed]
Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med. 2016; 375: 2223–35. [crossref] [PubMed]
Wei Z, Xie J, Wang K, Kang L, Dai Q, Bai J, et al. Comparison of percutaneous coronary intervention versus coronary artery bypass graft in aged patients with unprotected left main artery lesions. Int Heart J. 2016; 57:682–88. [crossref] [PubMed]
Yin Y, Xin X, Geng T, Xu Z. Clinical comparison of percutaneous coronary intervention with domestic drug-eluting stents versus off pump coronary artery bypass grafting in unprotected left main coronary artery disease. Int J Clin Exp Med. 2015; 8:14376–82.
Kawecki D, Morawiec B, Fudal M, Milejski W, Jachec W, Nowalany-Kozielska E, et al. Comparison of coronary artery bypass grafting with percutaneous coronary intervention for unprotected left main coronary artery disease. Yonsei Med J.2012; 53(1):58-67. [crossref] [PubMed]
Naganuma T, Chieffo A, Meliga E, Capodanno D, Park SJ, Onuma Y, et al. Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. JACC Cardiovasc Interv. 2014; 7:354–61. [crossref] [PubMed]
Rathod KS, Beirne AM, Bogle R, Firoozi S, Lim P, Hill J, et al. Prior coronary artery bypass graft surgery and outcome after percutaneous coronary intervention: an observational study from the pan-London percutaneous coronary intervention registry. J Am Heart Assoc.2020; 9:e014409. [crossref] [PubMed]
Nonaka M, Komiya T, Shimamoto T, Matsuo T. Multiple percutaneous coronary interventions may negatively impact cardiac remodeling after bypass surgery. Eur J Cardiothorac Surg. 2021; eza198. [crossref] [PubMed]
Wang S, Lyu Y, Cheng S, Liu J, Borah BJ. Clinical outcomes of patients with coronary artery diseases and moderate left ventricular dysfunction: percutaneous coronary intervention versus coronary artery bypass graft surgery. Ther Clin Risk Manag. 2021; 17:1103–11. [crossref] [PubMed]
Steigen T, Holm NR, Myrmel T, Endresen PC, Trovik T, Mäkikallio T, et al. Agestratified outcome in treatment of left maincoronary artery stenosis: A NOBLE trial sub study. Cardiology. 2021; 146:409–18. [crossref] [PubMed]
Guo L, Lv H, Zhong L, Wu J, Ding H, Xu J, et al. Gender differences in longterm outcomes of medical therapy and successful percutaneous coronary intervention for coronary chronic total occlusions.J Interv Cardiol. 2019; 2017958:1-8. [crossref] [PubMed]
Farag M, Gue YX, Brilakis ES, Egred M. Meta-analysis comparing outcomes of percutaneous coronary intervention of native artery versus bypass graft in patients with prior coronary artery bypass grafting. Am J Cardiol. 2021; 140:47-54. [crossref] [PubMed]
Lakshman HVVSS, Rao DV. Revascularization in ischemic heart failure: A review. Indian J Clin Cardiol. 2020: 1(1) 31-36. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/51190.16279

Date of Submission: Jul 03, 2021
Date of Peer Review: Oct 05, 2021
Date of Acceptance: Dec 11, 2021
Date of Publishing: May 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jul 05, 2021
• Manual Googling: Nov 19, 2021
• iThenticate Software: Dec 08, 2021 (11%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)