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. 2023 Apr 17;85(6):2849-2857.
doi: 10.1097/MS9.0000000000000634. eCollection 2023 Jun.

Percutaneous coronary intervention versus coronary artery bypass grafting among patients with left ventricular systolic dysfunction: a systematic review and meta-analysis

Vikash Jaiswal  1   2 , Song Peng Ang  3 , Abhigan Babu Shrestha  4 , Amey Joshi  2 , Angela Ishak  2 , Jia Ee Chia  2   5 , Sanchita Suresh Kanakannavr  2 , Sidra Naz  6 , Neel Doshi  7 , Dhairya Nanavaty  8 , Asmita Gera  2 , Vikash Kumar  8 , Farshid Daneshvar  9 , David Song  10 , Kripa Rajak  11
Affiliations

Percutaneous coronary intervention versus coronary artery bypass grafting among patients with left ventricular systolic dysfunction: a systematic review and meta-analysis

Vikash Jaiswal et al. Ann Med Surg (Lond). .

Abstract

Current guidelines have shown the superiority of coronary artery bypass grafting (CABG) over medical therapy. However, there is a paucity of data evaluating the optimal revascularization strategy in patients with ischemic left ventricular systolic dysfunction (LVSD).

Objective: The authors aimed to evaluate the clinical outcomes of postpercutaneous coronary intervention (PCI) and CABG among patients with LVSD.

Methods: The authors performed a systematic literature search using the PubMed, Embase, Scopus, and the Cochrane Libraries for relevant articles from inception until 30 November 2022. Outcomes were reported as pooled odds ratio (OR), and their corresponding 95% CI using STATA (version 17.0, StataCorp).

Results: A total of 10 studies with 13 324 patients were included in the analysis. The mean age of patients in PCI was 65.3 years, and 64.1 years in the CABG group. The most common comorbidities included: HTN (80 vs. 78%) and DM (49.2 vs. 49%). The mean follow-up duration was 3.75 years. Compared with CABG, the PCI group had higher odds of all-cause mortality (OR 1.15, 95% CI 1.01-1.31, P=0.03), repeat revascularization (OR 3.57, 95% CI 2.56-4.97, P<0.001), MI (OR 1.92, 95% CI 1.01-3.86, P=0.048) while the incidence of cardiovascular mortality (OR 1.23, 95% CI 0.98-1.55, P=0.07), stroke (OR 0.73 95% CI: 0.51-1.04, P=0.08), major adverse cardiovascular and cerebrovascular events (OR 1.36, 95% CI 0.99-1.87, P=0.06), and ventricular tachycardia (OR 0.79, 95% CI 0.22-2.86, P=0.72) was comparable between both the procedures.

Conclusion: The results of this meta-analysis suggest that CABG is superior to PCI for patients with LVSD. CABG was associated with a lower risk of all-cause mortality, repeat revascularization, and incidence of myocardial infarction compared with PCI in patients with LVSD.

Keywords: acute coronary syndrome; cardiomyopathy; coronary artery bypass grafting; ischemia; percutaneous coronary interventions; revascularization.

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Conflict of interest statement

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Figures

Figure 1
Figure 1
Preferred Reporting items for Systematic review and Meta-analysis flow of the search strategy for systematic review and meta-analysis.
Figure 2
Figure 2
Forest plots of outcomes: (A) All-cause mortality, (B) Repeat revascularization, (C) Myocardial Infarction. CABG, coronary artery bypass grafting; PCI, postpercutaneous coronary intervention.
Figure 3
Figure 3
Forest plot of outcomes: (A) Cardiovascular mortality, (B) Stroke. CABG, coronary artery bypass grafting; PCI, postpercutaneous coronary intervention.
Figure 4
Figure 4
Forest plots of outcomes: (A) MACCE, (B) Ventricular Tachycardia. CABG, coronary artery bypass grafting; PCI, postpercutaneous coronary intervention.
See this image and copyright information in PMC

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